Streptococcus pneumoniae is a known notorious cause of invasive pneumococcal diseases as well as asymptomatic host carriage. Efforts have been made to curb this infectious organism through various vaccine strategies. ...Streptococcus pneumoniae is a known notorious cause of invasive pneumococcal diseases as well as asymptomatic host carriage. Efforts have been made to curb this infectious organism through various vaccine strategies. However, its several strains and serotypes have necessitated various vaccine schedules and updates in the USA and globally. The evolution in pneumococcal vaccine schedules is not without challenges, such as cost, vaccine hesitancy, uptake and global disparities. This narrative review synopsizes the history of the Pneumococcal Vaccine and changes in its schedules in the last two decades based on published data. We focused on the impact of pneumococcal vaccination on invasive pneumococcal diseases, historical limitations, current challenges and future directions. Despite advancements in vaccination against S. pneumoniae infections, some pertinent issues exist that need to be swiftly fixed, to reduce national and thus global burden of pneumococcal diseases.展开更多
BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well...BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.展开更多
Objective: This systematic review examines the impact of lifestyle factors on migraine frequency and severity through a comprehensive analysis of lifestyle factors such as diet, physical activity, sleep patterns, stre...Objective: This systematic review examines the impact of lifestyle factors on migraine frequency and severity through a comprehensive analysis of lifestyle factors such as diet, physical activity, sleep patterns, stress, mental health, and environmental influences. Methods: We thoroughly searched Google Scholar, PUBMED, Scopus, and Web of Science databases using keywords related to migraines and lifestyle factors. Keywords incorporated the Boolean operator “and” to narrow search results. Following the PRISMA guidelines, we identified, screened, and evaluated studies for inclusion, resulting in nine studies meeting the eligibility criteria. Results: A total of 4917 records were initially identified from Scopus (2786), PubMed (854), and Web of Science (1277). Following deduplication, 3657 records underwent title screening, with 382 additionally screened by abstract. Ultimately, 88 full-text articles were assessed, resulting in 9 studies meeting eligibility for qualitative synthesis: 7 prospective and 2 retrospective studies. Our findings highlight the multifaceted role of lifestyle factors in migraine pathophysiology and management. Dietary habits, such as high-calorie, high-fat, and gluten-containing diets were linked to migraine triggers. Moderate physical activity showed beneficial effects on migraine management, while intense exercise could exacerbate symptoms. Poor sleep hygiene and insomnia were strongly associated with increased migraine frequency and severity. Chronic stress and poor mental health significantly contributed to migraine exacerbation, with stress management techniques proving beneficial. Environmental factors, including light, sound, weather changes, and allergens, were also identified as significant migraine triggers. Conclusions: Personalized lifestyle modifications, tailored to individual patient profiles, are crucial in managing migraines. Evidence-based recommendations include balanced diets, moderate physical activity, improved sleep hygiene, stress management techniques, and environmental adaptations.展开更多
Background: Obesity has become a serious global public health challenge, given that it leads to various adverse health outcomes that include cardiovascular illnesses, diabetes, and certain types of cancer. The World H...Background: Obesity has become a serious global public health challenge, given that it leads to various adverse health outcomes that include cardiovascular illnesses, diabetes, and certain types of cancer. The World Health Organization (WHO) has estimated that, at the end of 2022, 1 out of every 8 individuals were obese, and that the global adult obesity rates have over doubled since 1990, even as the adolescent obesity rates have quadrupled. Thus, as of 2022, nearly 2.5 billion adults, aged 18 years and above, were overweight, with 890 million being obese. Obesity and overweight incidence rate has been gradually increasing over the years, presenting significant challenges to the healthcare systems throughout the globe. In this regard, the objective of this systematic review was to evaluate the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. Methodology: To attain the above stated study objective, a systematic evaluation of previous studies was carried out, particularly studies that assessed the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. The authors have used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the selection of eligible studies for inclusion in the study. Results: The findings indicate that lifestyle interventions resulted in 5% - 10% weight reduction and significant improvements in metabolic indicators, while pharmacotherapy (GLP-1 receptor agonists) achieved up to 15% weight reduction and considerable metabolic health benefits. Further, comparative studies show lifestyle modifications provide overall health benefits, while medication is necessary for non-responders. Conclusion: Individualized treatment strategies are crucial, and further research is needed on long-term consequences and combination therapies.展开更多
Artificial intelligence(AI)is the study of algorithms that enable machines to analyze and execute cognitive activities including problem solving,object and word recognition,reduce the inevitable errors to improve the ...Artificial intelligence(AI)is the study of algorithms that enable machines to analyze and execute cognitive activities including problem solving,object and word recognition,reduce the inevitable errors to improve the diagnostic accuracy,and decision-making.Hepatobiliary procedures are technically complex and the use of AI in perioperative management can improve patient outcomes as discussed below.Three-dimensional(3D)reconstruction of images obtained via ultrasound,computed tomography scan or magnetic resonance imaging,can help surgeons better visualize the surgical sites with added depth perception.Preoperative 3D planning is associated with lesser operative time and intraoperative complications.Also,a more accurate assessment is noted,which leads to fewer operative complications.Images can be converted into physical models with 3D printing technology,which can be of educational value to students and trainees.3D images can be combined to provide 3D visualization,which is used for preoperative navigation,allowing for more precise localization of tumors and vessels.Nevertheless,AI enables surgeons to provide better,personalized care for each patient.展开更多
BACKGROUND Despite the use of current standard therapy,the prognosis of patients with unresectable hepatocellular carcinoma(HCC)is poor,with median survival times of 40 mo for intermediate HCC(Barcelona Clinic Liver C...BACKGROUND Despite the use of current standard therapy,the prognosis of patients with unresectable hepatocellular carcinoma(HCC)is poor,with median survival times of 40 mo for intermediate HCC(Barcelona Clinic Liver Cancer[BCLC]stage B)and 6-8 mo for advanced HCC(BCLC stage C).Although patients with earlystage HCC are usually suitable for therapies with curative intention,up to 70% of patients experience relapse within 5 years.In the past decade,the United States Food and Drug Administration has approved different immunogenic treatment options for advanced HCC,the most common type of liver cancer among adults.Nevertheless,no treatment is useful in the adjuvant setting.Since 2007,the multikinase inhibitor sorafenib has been used as a first-line targeted drug to address the increased mortality and incidence rates of HCC.However,in 2020,the IMbrave150 trial demonstrated that combination therapy of atezolizumab(antiprogrammed death-ligand 1[PD-L1])and bevacizumab(anti-vascular endothelial growth factor[VEGF])is superior to sorafenib,a single anti-programmed death 1/PD-L1 antibody inhibitor used as an anti-cancer monotherapy for HCC treatment.AIM To conduct a systematic literature review to evaluate the evidence supporting the efficacy and safety of atezolizumab/bevacizumab as preferred first-line drug therapy over the conventional sorafenib or atezolizumab monotherapies,which are used to improve survival outcomes and reduce disease progression in patients with unresectable HCC and non-decompensated liver disease.METHODS A comprehensive literature review was conducted using the PubMed,Scopus,ScienceDirect,clinicaltrials.gov,PubMed Central,Embase,EuropePMC,and CINAHL databases to identify studies that met the inclusion criteria using relevant MeSH terms.This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and risk of bias(RoB)were assessed using the Cochrane RoB 2 tool and Sevis.RESULTS In the atezolizumab/bevacizumab group,an improvement in overall tumor response,reduction of disease progression,and longer progression-free survival were observed compared to monotherapy with either sorafenib or atezolizumab.Hypertension and proteinuria were the most common adverse events,and the rates of adverse events were comparable to those with the monotherapy.Of the studies,there were two completed trials and two ongoing trials analyzed using high quality and low bias.A more thorough analysis was only performed on the completed trials.CONCLUSION Treatment of HCC with atezolizumab/bevacizumab combination therapy was confirmed to be an effective first-line treatment to improve survival in patients with unresectable HCC and non-decompensated liver disease compared to monotherapy with either sorafenib or atezolizumab.展开更多
Dear Editor,I am Dr.Austin Bach from Larkin Community Hospital in South Miami,Florida,USA.I am writing to you to present three cases of inflammatory optic neuritis that was followed to resolution using pattern electro...Dear Editor,I am Dr.Austin Bach from Larkin Community Hospital in South Miami,Florida,USA.I am writing to you to present three cases of inflammatory optic neuritis that was followed to resolution using pattern electroretinography（PERG）.展开更多
<strong>Background:</strong> COVID-19 is an ongoing global pandemic with paucity of the understanding of the natural history of the disease and how it affects smokers. We aim to study the outcomes of COVID...<strong>Background:</strong> COVID-19 is an ongoing global pandemic with paucity of the understanding of the natural history of the disease and how it affects smokers. We aim to study the outcomes of COVID-19 in smokers in this descriptive review. Coronavirus disease 2019 caused by severe acute respiratory syndrome Coronavirus 2, gains entry to bronchial epithelial cells by attachment of the viral spike protein to Angiotensin-Converting Enzyme-2 (ACE-2) receptors. Accordingly, this review aims to understand the associated risk and worsen disease in relation to smoking and explore conflicting information regarding nicotine as well as its potential protective role. <strong>Methods:</strong> We conducted a non-systematic review of databases with search engines such as, PubMed, Google Scholar with keywords like “COVID-19,” “SARS-CoV-2,” “novel coronavirus,” smoking,” “smokers,” “nicotine.” It included English articles related to the epidemiology of COVID-19 in adult smokers, containing systematic reviews, meta-analysis, prospective and retrospective cohort studies, cross-sectional studies, case series, and case reports based on the relevance of titles and abstracts to the topic. <strong>Results: </strong>A total of 33 articles were reviewed. Smokers were 1.4 times more likely to have severe COVID-19 (RR = 1.4, 95% CI: 0.98 - 2.00), and 2.4 times more likely to require an ICU admission (RR = 2.4, CI: 1.43 - 4.04) when compared to non-smokers (n = 926). Current smokers were less likely to experience an adverse outcome (OR: 0.42, 95% CI: 0.24 - 0.74), compared to former smokers. 22% of current smokers and 46% of former smokers had more severe complications compared to non-smokers with COVID-19 infection. Current smokers had a case fatality rate of 38.5% (n = 1790). They had higher odds of mortality compared to non-smokers (OR = 1.25), especially males > 65 years age (OR = 2.51). Tobacco smoke upregulates inflammatory cytokines like TNF-α, IL-1β, and neutrophils by activating NF-k. Hence, it leads to increased epithelial cell permeability, mucus production, and impaired mucociliary clearance. The pro-inflammatory action of tobacco smoke impairs the basal laminar cells and causes endothelial dysfunction of the BBB and blood vessels, which leads to neurological, cerebrovascular, and thrombotic complications. <strong>Conclusion:</strong> Smoking is associated with worse outcomes and mortality in COVID-19. Public education about smoking cessation should be implemented along with standard guidelines to prevent disease progression in this susceptible population.展开更多
Upper tract urothelial cell carcinoma(UTUCC),formerly known as transitional cell carcinoma of the upper urinary tract,is a rare oncologic disease in Western countries.Thus its disease process and its management are no...Upper tract urothelial cell carcinoma(UTUCC),formerly known as transitional cell carcinoma of the upper urinary tract,is a rare oncologic disease in Western countries.Thus its disease process and its management are not as well defined as other urologic cancers. We are reviewing the current evidence based literature available to develop a plan for the treatment of UTUCC. A Pub Med search was completed using the key words "upper tract urothelial cell carcinoma","epidemiology","risk factor","treatment" and "prognosis". Six hundred fifty two articles were found. We narrowed our search to articles published between January 2004 and June 2016 for a more contemporary review of the topic. Four hundred seventy articles were then available for review. Further detailed search was performed for relevance on the topic and hundred one articles were selected for the review. Many risk factors have been found to be associated with the development of UTUCC,including tobacco use. Patients are often asymptomatic and may only present with microscopic or gross hematuria. Tumor grade and stage are pivotal in determining the treatment options for UTUCC. Advancements in endoscopic techniques have aided in the diagnosis,grading and treatment of this disease. Treatment options include topical therapy,with combinations of methotrexate,vinblastine,doxorubicin and cisplatin or gemcitibine or cisplatin,endoscopic resection,segmental ureterectomy and ureteral implantation,and nephroureterectomy,including bladder cuff. Treatment recommendations depend on tumor grade and stage,renal function,tumor location and the patient's prognosis. There are currently no tissue or blood-based biomarkers available to accurately monitor the disease. Further studies of gene expression and biomarkers may hopefully improve the management of this disease. Although rare in many countries,UTUCC is becoming more prevalent due to exposure to carcinogenic herbal remedies and other identifiable risk factors. Numerous treatment modalities,both surgical and chemotherapeutic,have been utilized to treat both low and high grade UTUCC tumors. Additional clinical trials are necessary to further develop methods for screening,treatment,and surveillance to improve management.展开更多
Background We aimed to systematically review the clinical and laboratory features of patients with the multisystem inflam-matory syndrome in pediatrics diagnosed during the COVID-19 pandemic.Data sources A literature ...Background We aimed to systematically review the clinical and laboratory features of patients with the multisystem inflam-matory syndrome in pediatrics diagnosed during the COVID-19 pandemic.Data sources A literature search in Web of Science,PubMed,Scopus,and Science Direct was made up to June 29,2020.Results Analysis of 15 articles(318 COVID-19 patients)revealed that although many patients presented with the typical multisystem inflammatory syndrome in pediatrics,Kawasaki-like features as fever(82.4%),polymorphous maculopapular exanthema(63.7%),oral mucosal changes(58.1%),conjunctival injections(56.0%),edematous extremities(40.7%),and cervical lymphadenopathy(28.5%),atypical gastrointestinal(79.4%)and neurocognitive symptoms(31.8%)were also com-mon.They had elevated serum lactic acid dehydrogenase,D-dimer,C-reactive protein,procalcitonin,interleukin-6,troponin I levels,and lymphopenia.Nearly 77.0%developed hypotension,and 68.1%went into shock,while 41.1%had acute kidney injury.Intensive care was needed in 73.7%of cases;13.2%were intubated,and 37.9%required mechanical ventilation.Intravenous immunoglobulins and steroids were given in 87.7%and 56.9%of the patients,respectively,and anticoagulants were utilized in 67.0%.Pediatric patients were discharged after a hospital stay of 6.77 days on average(95%CI 4.93-8.6).Conclusions Recognizing the typical and atypical presentation of the multisystem inflammatory syndrome in pediatric COVID-19 patients has important implications in identifying children at risk.Monitoring cardiac and renal decompensation and early interventions in patients with multisystem inflammatory syndrome is critical to prevent further morbidity.展开更多
Background:Patients with Sturge-Weber syndrome can have ipsilateral diffuse or circumscribed choroidal hemangiomas.These hemangiomas have been seen to undergo spontaneous exudative or hemorrhagic retinal detachments.T...Background:Patients with Sturge-Weber syndrome can have ipsilateral diffuse or circumscribed choroidal hemangiomas.These hemangiomas have been seen to undergo spontaneous exudative or hemorrhagic retinal detachments.There is no definitive treatment for these types of retinal detachments,but radiotherapy,photodynamic therapy,oral propranolol,pegaptinib and bevacizumab have been used.Case presentation:A 26-year-old male with Sturge-Weber Syndrome developed an exudative retinal detachment that occurred immediately after taking a supplement containing arginine.The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 ml solution.Resolution of the retinal detachment was seen after 4 treatments over a six-month period.Conclusions:Arginine and other medications that cause a release of nitric oxide may lead to intravascular leakage and exudative retinal detachments in patients who have a choroidal hemangioma.展开更多
Prostate cancer(PCa)screening remains one of the most controversial topics in clinical and public health.Despite being the second most common cancer in men worldwide,recommendations for screening using prostate-specif...Prostate cancer(PCa)screening remains one of the most controversial topics in clinical and public health.Despite being the second most common cancer in men worldwide,recommendations for screening using prostate-specific antigen(PSA)are unclear.Early detection and the resulting postscreening treatment lead to overdiagnosis and overtreatment of otherwise indolent cases.In addition,several unwanted harms are associated with PCa screening process.This literature review focuses on the limitations of PSA-specific PCa screening,reasons behind the screening controversy,and the novel biomarkers and advanced innovative methodologies that improve the limitations of traditional screening using PSA.With the verdict of whether or not to screen not yet unanimous,we hope to aid in resolution of the long-standing debate.展开更多
文摘Streptococcus pneumoniae is a known notorious cause of invasive pneumococcal diseases as well as asymptomatic host carriage. Efforts have been made to curb this infectious organism through various vaccine strategies. However, its several strains and serotypes have necessitated various vaccine schedules and updates in the USA and globally. The evolution in pneumococcal vaccine schedules is not without challenges, such as cost, vaccine hesitancy, uptake and global disparities. This narrative review synopsizes the history of the Pneumococcal Vaccine and changes in its schedules in the last two decades based on published data. We focused on the impact of pneumococcal vaccination on invasive pneumococcal diseases, historical limitations, current challenges and future directions. Despite advancements in vaccination against S. pneumoniae infections, some pertinent issues exist that need to be swiftly fixed, to reduce national and thus global burden of pneumococcal diseases.
文摘BACKGROUND Leg length discrepancy(LLD)following total hip arthroplasty(THA)is a common complaint,leading to decreased patient satisfaction.However,the effect of LLD before THA on outcomes and complications is not well defined.AIM To assess the effect of prior LLD on rates of falls,implant-related complications,stay length,readmissions,and implant survival following THA.METHODS A retrospective review of a nationwide insurance database was conducted from 2010 to 2021.All cases of THA and those with a prior diagnosis of LLD were identified.THA patients with LLD were matched to control patients 1:5 based on demographic and comorbidity profiles.Two-year fall rates and implant complications,lengths of stay,90-day readmissions,and time to revision were compared between cohorts.RESULTS A total of 2038 patients with LLD were matched to 10165 control patients.The LLD group showed significantly greater rates of falls[odds ratio(OR)=1.58;95%confidence interval(95%CI):1.24-2.01],dislocation(OR=2.61;95%CI:2.10-3.24),mechanical loosening(OR=4.58;95%CI:3.28-6.29),and periprosthetic fracture(OR=2.70;95%CI:1.96-3.72)compared to the control group(all P<0.001).Mean length of stay(LOS)was also significantly higher in the LLD group(3.1 days vs 2.8 days,P=0.034).No significant difference in 90-day readmission rates(7.75%vs 7.02%,P=0.244)was observed between the groups(P=0.244).Time to revision was significantly less in the LLD group(225 days vs 544 days,P<0.001).CONCLUSION LLD in patients having THA is related with significantly higher fall risk,rates of implant-related complications,LOS,and quicker time to revision.Identifying patients with LLD before their THA may help in identifying risks,better patient counselling,and more effective preoperative planning.However,the study have important limitations:Its design lacks information on the degree and cause of LLD,the time between diagnosis and surgery,and which leg with the discrepancy underwent the operation.Future well-designed studies should confirm the findings of this study.
文摘Objective: This systematic review examines the impact of lifestyle factors on migraine frequency and severity through a comprehensive analysis of lifestyle factors such as diet, physical activity, sleep patterns, stress, mental health, and environmental influences. Methods: We thoroughly searched Google Scholar, PUBMED, Scopus, and Web of Science databases using keywords related to migraines and lifestyle factors. Keywords incorporated the Boolean operator “and” to narrow search results. Following the PRISMA guidelines, we identified, screened, and evaluated studies for inclusion, resulting in nine studies meeting the eligibility criteria. Results: A total of 4917 records were initially identified from Scopus (2786), PubMed (854), and Web of Science (1277). Following deduplication, 3657 records underwent title screening, with 382 additionally screened by abstract. Ultimately, 88 full-text articles were assessed, resulting in 9 studies meeting eligibility for qualitative synthesis: 7 prospective and 2 retrospective studies. Our findings highlight the multifaceted role of lifestyle factors in migraine pathophysiology and management. Dietary habits, such as high-calorie, high-fat, and gluten-containing diets were linked to migraine triggers. Moderate physical activity showed beneficial effects on migraine management, while intense exercise could exacerbate symptoms. Poor sleep hygiene and insomnia were strongly associated with increased migraine frequency and severity. Chronic stress and poor mental health significantly contributed to migraine exacerbation, with stress management techniques proving beneficial. Environmental factors, including light, sound, weather changes, and allergens, were also identified as significant migraine triggers. Conclusions: Personalized lifestyle modifications, tailored to individual patient profiles, are crucial in managing migraines. Evidence-based recommendations include balanced diets, moderate physical activity, improved sleep hygiene, stress management techniques, and environmental adaptations.
文摘Background: Obesity has become a serious global public health challenge, given that it leads to various adverse health outcomes that include cardiovascular illnesses, diabetes, and certain types of cancer. The World Health Organization (WHO) has estimated that, at the end of 2022, 1 out of every 8 individuals were obese, and that the global adult obesity rates have over doubled since 1990, even as the adolescent obesity rates have quadrupled. Thus, as of 2022, nearly 2.5 billion adults, aged 18 years and above, were overweight, with 890 million being obese. Obesity and overweight incidence rate has been gradually increasing over the years, presenting significant challenges to the healthcare systems throughout the globe. In this regard, the objective of this systematic review was to evaluate the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. Methodology: To attain the above stated study objective, a systematic evaluation of previous studies was carried out, particularly studies that assessed the effectiveness and safety of lifestyle modifications (diet and physical activity) and pharmacotherapy in promoting weight loss and improving metabolic health in overweight adults. The authors have used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in the selection of eligible studies for inclusion in the study. Results: The findings indicate that lifestyle interventions resulted in 5% - 10% weight reduction and significant improvements in metabolic indicators, while pharmacotherapy (GLP-1 receptor agonists) achieved up to 15% weight reduction and considerable metabolic health benefits. Further, comparative studies show lifestyle modifications provide overall health benefits, while medication is necessary for non-responders. Conclusion: Individualized treatment strategies are crucial, and further research is needed on long-term consequences and combination therapies.
文摘Artificial intelligence(AI)is the study of algorithms that enable machines to analyze and execute cognitive activities including problem solving,object and word recognition,reduce the inevitable errors to improve the diagnostic accuracy,and decision-making.Hepatobiliary procedures are technically complex and the use of AI in perioperative management can improve patient outcomes as discussed below.Three-dimensional(3D)reconstruction of images obtained via ultrasound,computed tomography scan or magnetic resonance imaging,can help surgeons better visualize the surgical sites with added depth perception.Preoperative 3D planning is associated with lesser operative time and intraoperative complications.Also,a more accurate assessment is noted,which leads to fewer operative complications.Images can be converted into physical models with 3D printing technology,which can be of educational value to students and trainees.3D images can be combined to provide 3D visualization,which is used for preoperative navigation,allowing for more precise localization of tumors and vessels.Nevertheless,AI enables surgeons to provide better,personalized care for each patient.
文摘BACKGROUND Despite the use of current standard therapy,the prognosis of patients with unresectable hepatocellular carcinoma(HCC)is poor,with median survival times of 40 mo for intermediate HCC(Barcelona Clinic Liver Cancer[BCLC]stage B)and 6-8 mo for advanced HCC(BCLC stage C).Although patients with earlystage HCC are usually suitable for therapies with curative intention,up to 70% of patients experience relapse within 5 years.In the past decade,the United States Food and Drug Administration has approved different immunogenic treatment options for advanced HCC,the most common type of liver cancer among adults.Nevertheless,no treatment is useful in the adjuvant setting.Since 2007,the multikinase inhibitor sorafenib has been used as a first-line targeted drug to address the increased mortality and incidence rates of HCC.However,in 2020,the IMbrave150 trial demonstrated that combination therapy of atezolizumab(antiprogrammed death-ligand 1[PD-L1])and bevacizumab(anti-vascular endothelial growth factor[VEGF])is superior to sorafenib,a single anti-programmed death 1/PD-L1 antibody inhibitor used as an anti-cancer monotherapy for HCC treatment.AIM To conduct a systematic literature review to evaluate the evidence supporting the efficacy and safety of atezolizumab/bevacizumab as preferred first-line drug therapy over the conventional sorafenib or atezolizumab monotherapies,which are used to improve survival outcomes and reduce disease progression in patients with unresectable HCC and non-decompensated liver disease.METHODS A comprehensive literature review was conducted using the PubMed,Scopus,ScienceDirect,clinicaltrials.gov,PubMed Central,Embase,EuropePMC,and CINAHL databases to identify studies that met the inclusion criteria using relevant MeSH terms.This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and risk of bias(RoB)were assessed using the Cochrane RoB 2 tool and Sevis.RESULTS In the atezolizumab/bevacizumab group,an improvement in overall tumor response,reduction of disease progression,and longer progression-free survival were observed compared to monotherapy with either sorafenib or atezolizumab.Hypertension and proteinuria were the most common adverse events,and the rates of adverse events were comparable to those with the monotherapy.Of the studies,there were two completed trials and two ongoing trials analyzed using high quality and low bias.A more thorough analysis was only performed on the completed trials.CONCLUSION Treatment of HCC with atezolizumab/bevacizumab combination therapy was confirmed to be an effective first-line treatment to improve survival in patients with unresectable HCC and non-decompensated liver disease compared to monotherapy with either sorafenib or atezolizumab.
文摘Dear Editor,I am Dr.Austin Bach from Larkin Community Hospital in South Miami,Florida,USA.I am writing to you to present three cases of inflammatory optic neuritis that was followed to resolution using pattern electroretinography（PERG）.
文摘<strong>Background:</strong> COVID-19 is an ongoing global pandemic with paucity of the understanding of the natural history of the disease and how it affects smokers. We aim to study the outcomes of COVID-19 in smokers in this descriptive review. Coronavirus disease 2019 caused by severe acute respiratory syndrome Coronavirus 2, gains entry to bronchial epithelial cells by attachment of the viral spike protein to Angiotensin-Converting Enzyme-2 (ACE-2) receptors. Accordingly, this review aims to understand the associated risk and worsen disease in relation to smoking and explore conflicting information regarding nicotine as well as its potential protective role. <strong>Methods:</strong> We conducted a non-systematic review of databases with search engines such as, PubMed, Google Scholar with keywords like “COVID-19,” “SARS-CoV-2,” “novel coronavirus,” smoking,” “smokers,” “nicotine.” It included English articles related to the epidemiology of COVID-19 in adult smokers, containing systematic reviews, meta-analysis, prospective and retrospective cohort studies, cross-sectional studies, case series, and case reports based on the relevance of titles and abstracts to the topic. <strong>Results: </strong>A total of 33 articles were reviewed. Smokers were 1.4 times more likely to have severe COVID-19 (RR = 1.4, 95% CI: 0.98 - 2.00), and 2.4 times more likely to require an ICU admission (RR = 2.4, CI: 1.43 - 4.04) when compared to non-smokers (n = 926). Current smokers were less likely to experience an adverse outcome (OR: 0.42, 95% CI: 0.24 - 0.74), compared to former smokers. 22% of current smokers and 46% of former smokers had more severe complications compared to non-smokers with COVID-19 infection. Current smokers had a case fatality rate of 38.5% (n = 1790). They had higher odds of mortality compared to non-smokers (OR = 1.25), especially males > 65 years age (OR = 2.51). Tobacco smoke upregulates inflammatory cytokines like TNF-α, IL-1β, and neutrophils by activating NF-k. Hence, it leads to increased epithelial cell permeability, mucus production, and impaired mucociliary clearance. The pro-inflammatory action of tobacco smoke impairs the basal laminar cells and causes endothelial dysfunction of the BBB and blood vessels, which leads to neurological, cerebrovascular, and thrombotic complications. <strong>Conclusion:</strong> Smoking is associated with worse outcomes and mortality in COVID-19. Public education about smoking cessation should be implemented along with standard guidelines to prevent disease progression in this susceptible population.
文摘Upper tract urothelial cell carcinoma(UTUCC),formerly known as transitional cell carcinoma of the upper urinary tract,is a rare oncologic disease in Western countries.Thus its disease process and its management are not as well defined as other urologic cancers. We are reviewing the current evidence based literature available to develop a plan for the treatment of UTUCC. A Pub Med search was completed using the key words "upper tract urothelial cell carcinoma","epidemiology","risk factor","treatment" and "prognosis". Six hundred fifty two articles were found. We narrowed our search to articles published between January 2004 and June 2016 for a more contemporary review of the topic. Four hundred seventy articles were then available for review. Further detailed search was performed for relevance on the topic and hundred one articles were selected for the review. Many risk factors have been found to be associated with the development of UTUCC,including tobacco use. Patients are often asymptomatic and may only present with microscopic or gross hematuria. Tumor grade and stage are pivotal in determining the treatment options for UTUCC. Advancements in endoscopic techniques have aided in the diagnosis,grading and treatment of this disease. Treatment options include topical therapy,with combinations of methotrexate,vinblastine,doxorubicin and cisplatin or gemcitibine or cisplatin,endoscopic resection,segmental ureterectomy and ureteral implantation,and nephroureterectomy,including bladder cuff. Treatment recommendations depend on tumor grade and stage,renal function,tumor location and the patient's prognosis. There are currently no tissue or blood-based biomarkers available to accurately monitor the disease. Further studies of gene expression and biomarkers may hopefully improve the management of this disease. Although rare in many countries,UTUCC is becoming more prevalent due to exposure to carcinogenic herbal remedies and other identifiable risk factors. Numerous treatment modalities,both surgical and chemotherapeutic,have been utilized to treat both low and high grade UTUCC tumors. Additional clinical trials are necessary to further develop methods for screening,treatment,and surveillance to improve management.
文摘Background We aimed to systematically review the clinical and laboratory features of patients with the multisystem inflam-matory syndrome in pediatrics diagnosed during the COVID-19 pandemic.Data sources A literature search in Web of Science,PubMed,Scopus,and Science Direct was made up to June 29,2020.Results Analysis of 15 articles(318 COVID-19 patients)revealed that although many patients presented with the typical multisystem inflammatory syndrome in pediatrics,Kawasaki-like features as fever(82.4%),polymorphous maculopapular exanthema(63.7%),oral mucosal changes(58.1%),conjunctival injections(56.0%),edematous extremities(40.7%),and cervical lymphadenopathy(28.5%),atypical gastrointestinal(79.4%)and neurocognitive symptoms(31.8%)were also com-mon.They had elevated serum lactic acid dehydrogenase,D-dimer,C-reactive protein,procalcitonin,interleukin-6,troponin I levels,and lymphopenia.Nearly 77.0%developed hypotension,and 68.1%went into shock,while 41.1%had acute kidney injury.Intensive care was needed in 73.7%of cases;13.2%were intubated,and 37.9%required mechanical ventilation.Intravenous immunoglobulins and steroids were given in 87.7%and 56.9%of the patients,respectively,and anticoagulants were utilized in 67.0%.Pediatric patients were discharged after a hospital stay of 6.77 days on average(95%CI 4.93-8.6).Conclusions Recognizing the typical and atypical presentation of the multisystem inflammatory syndrome in pediatric COVID-19 patients has important implications in identifying children at risk.Monitoring cardiac and renal decompensation and early interventions in patients with multisystem inflammatory syndrome is critical to prevent further morbidity.
文摘Background:Patients with Sturge-Weber syndrome can have ipsilateral diffuse or circumscribed choroidal hemangiomas.These hemangiomas have been seen to undergo spontaneous exudative or hemorrhagic retinal detachments.There is no definitive treatment for these types of retinal detachments,but radiotherapy,photodynamic therapy,oral propranolol,pegaptinib and bevacizumab have been used.Case presentation:A 26-year-old male with Sturge-Weber Syndrome developed an exudative retinal detachment that occurred immediately after taking a supplement containing arginine.The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 ml solution.Resolution of the retinal detachment was seen after 4 treatments over a six-month period.Conclusions:Arginine and other medications that cause a release of nitric oxide may lead to intravascular leakage and exudative retinal detachments in patients who have a choroidal hemangioma.
文摘Prostate cancer(PCa)screening remains one of the most controversial topics in clinical and public health.Despite being the second most common cancer in men worldwide,recommendations for screening using prostate-specific antigen(PSA)are unclear.Early detection and the resulting postscreening treatment lead to overdiagnosis and overtreatment of otherwise indolent cases.In addition,several unwanted harms are associated with PCa screening process.This literature review focuses on the limitations of PSA-specific PCa screening,reasons behind the screening controversy,and the novel biomarkers and advanced innovative methodologies that improve the limitations of traditional screening using PSA.With the verdict of whether or not to screen not yet unanimous,we hope to aid in resolution of the long-standing debate.
