Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity,affecting approximately 4%of the general population with incidence increasing with age and sedentary lifestyle.While conventional e...Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity,affecting approximately 4%of the general population with incidence increasing with age and sedentary lifestyle.While conventional excisional hemorrhoidectomy techniques such as Milligan-Morgan and Ferguson remain standard for long-term efficacy,they are often associated with substantial postoperative pain and prolonged recovery.This narrative review evaluates the comparative clinical outcomes of laser hemorrhoidoplasty(LHP)versus conventional surgical interventions in the treatment of grade II and III symptomatic hemorrhoids.A comprehensive analysis of comparative studies,randomized controlled trials,and meta-analyses published between 2020 and 2025 was conducted,with primary outcomes including postoperative pain,recovery time,operative duration,complication rates,and recurrence.Key findings from studies by Maloku et al and Hassan et al.were analyzed to contextualize real-world LHP use.Across multiple high-quality studies,LHP was consistently associated with significantly lower postoperative pain scores,reduced analgesic requirements,and faster return to daily activities.Maloku et al demonstrated a shorter mean operative time(15.9 minutes)and reduced pain compared to open techniques(26.8 minutes;P<0.01).Hassan et al confirmed these benefits in a cohort of 40 patients treated under local anesthesia.Operative time was generally comparable or shorter,and vessel ligation was suggested as an adjunct to improve outcomes in select cases.Complication rates were low and similar between groups,with LHP demonstrating minimal risk for major complications such as anal stenosis or incontinence.However,recurrence rates were higher with LHP in some studies,particularly in grade III disease.LHP offers a minimally invasive,low-morbidity alternative to excisional hemorrhoidectomy for appropriately selected patients.Despite superior short-term recovery profiles,potential for higher recurrence underscores the importance of patient selection and long-term follow-up.The role of local anesthesia and adjunctive vessel ligation merits further prospective evaluation.展开更多
1.Biochemical structure and molecular activity of meldonium Meldonium(commercial name Mildronate)was originally synthesized in the mid-1970s at the Institute of Organic Synthesis of the Latvian Soviet Socialist Republ...1.Biochemical structure and molecular activity of meldonium Meldonium(commercial name Mildronate)was originally synthesized in the mid-1970s at the Institute of Organic Synthesis of the Latvian Soviet Socialist Republic Academy of Sciences.The chemical structure of this compound(3-(2,2,2-展开更多
BACKGROUND The scientific literature provides evidence that nutritional ketosis can be an important support in the treatment of pathologies in which inflammation is present,as recent studies have shown that ketone bod...BACKGROUND The scientific literature provides evidence that nutritional ketosis can be an important support in the treatment of pathologies in which inflammation is present,as recent studies have shown that ketone bodies have anti-inflammatory activity in numerous diseases,including rheumatic diseases.We report the case of a 22-year-old woman with class I obesity and juvenile idiopathic arthritis who started treatment with a very low calorie ketogenic diet(VLCKD).CASE SUMMARY The patient was a 22-year-old woman diagnosed with juvenile idiopathic arthritis at age 4 years and with a body mass index(BMI)of 30.8 kg/m2,waist circumference(WC)80 cm,fat mass(FM)28.1 kg,free FM 45.7 kg,and visceral adipose tissue(VAT)3.5 kg,assessed on bioimpedance analysis.She was treated using a commercial VLCKD weight-loss program(PNK®method);this program provides high-biological-value protein preparations and natural foods.Each protein preparation contains 15 g protein,4 g carbohydrate,3 g fat,and 50 mg omega-3 docosahexaenoic acid,with an energy content of 90–120 kcal.After four months on the program,the BMI was 28.6 kg/m2,WC 73 cm,FM 23.2 kg,free FM 41.9 kg,and VAT 2.9 kg.CONCLUSION VLCKD enabled the patient to reach her target weight and to reduce her joint pain and headaches.Laboratory inflammatory indices also normalized.展开更多
Background:This study was planned to assess the accuracy and comparability of two commercially available,laboratory-based SARS-CoV-2(severe acute respiratory syndrome)antigen(Ag)immunoassays.Methods:We studied a cohor...Background:This study was planned to assess the accuracy and comparability of two commercially available,laboratory-based SARS-CoV-2(severe acute respiratory syndrome)antigen(Ag)immunoassays.Methods:We studied a cohort of subjects with acute SARS-CoV-2 infection,from whom a nasopharyngeal swab was taken and tested with a molecular assay(Altona Diagnostics RealStar SARS-CoV-2 RT-PCR Kit)and two laboratory-based,fully automated SARS-CoV-2 Ag immunoassays(Fujirebio Lumipulse G SARS-CoV-2 Ag and Roche Elecsys SARS-CoV-2 Ag).Results:The final population consisted in 93 subjects testing positive for SARS-CoV-2 RNA,34 with cycle threshold(Ct)values<29.5.The results of the two SARS-CoV-2 Ag immunoassays were significantly intercorrelated(r=0.77;P<0.001)in the entire cohort,though such correlation considerably improved in patients with high viral load(cycle threshold values<29.5:r=0.96;P<0.001).The accuracy for identifying samples with high viral load was excellent for both Lumipulse G SARS-CoV-2 Ag(AUC,0.99;P<0.001)and Elecsys SARS-CoV-2 Ag(AUC,0.99;P<0.001),with best cut-offs of 2.03 ng/mL for Lumipulse G SARS-CoV-2 Ag(1.00 sensitivity and 0.88 specificity)and 0.70 COI for Elecsys SARS-CoV-2 Ag(1.00 sensitivity and 0.80 specificity),respectively.Conclusion:The results of this study provide valuable support to usability of fully-automated,rapid,high throughput and accurate SARS-CoV-2 Ag immunoassays for complementing molecular assays.展开更多
Background:Health professions education(HPE)in underserved and resource-constrained regions faces persistent challenges,including limited faculty development opportunities and the absence of context-specific curricula...Background:Health professions education(HPE)in underserved and resource-constrained regions faces persistent challenges,including limited faculty development opportunities and the absence of context-specific curricula.The growing need to increase access to cataract surgery and reduce avoidable blindness underscores the urgency of training more competent cataract surgeons.Developing a standardized,nationally endorsed,outcome-based curriculum for simulation-based training in cataract surgery represents a strategic solution.This study explores integrating online active and constructivist social learning strategies within team projects to address these educational gaps,emphasizing equitable international partnerships between experienced global ophthalmological societies(GOS)in HPE,and national ophthalmological societies(NOS)especially in underserved regions.Methods:We conducted an non-experimental investigation involving the Mozambican College of Ophthalmology(NOS),comprising ten senior ophthalmologist educators,including the President(A.B.),each with over ten years of postgraduate teaching leadership experience.To promote inclusivity and foster future leadership,six early-career ophthalmologists with under five years of experience were invited to join.The GOS was represented by two ophthalmologist educators(K.G.and H.P.F.)affiliated with the Ophthalmology Foundation and experienced in international HPE.Together,both organizations formed an equitable and culturally adapted partnership,led by the NOS,to co-design an outcome-based curriculum for cataract surgery simulation training.The collaborative process used a group mentor-facilitated model integrating design thinking,and social constructivist strategies.A virtual community of practice(vCoP),sustained through WhatsApp,enabled continuous peer support and knowledge exchange.The project spanned eight monthly 90-minute videoconferences via Zoom,incorporating online group mentoring and a virtual jigsaw exercise.Results:The collaboration resulted in the development of a competency-based,simulation-enhanced small incision cataract surgery curriculum structured around the Ophthalmic Simulated Surgical Competency Assessment Rubric(Sim-OSSCAR).The curriculum followed Kern’s six-step framework and was organized into four modular components covering the full range of surgical steps.The vCoP emerged as a key platform for sustained faculty development,collaborative problem-solving,and shared expertise,enhancing institutional capacity within the NOS.Participants anecdotally reported increased confidence in curriculum design,strengthened mentoring relationships,and greater engagement through active learning methodologies.The model demonstrated scalability and adaptability,indicating potential for broader application across other medical specialties and contexts.Conclusions:This study highlights the transformative potential of combining design thinking,active and social learning strategies,and digital tools in HPE.By fostering equitable,structured international collaborations,this approach supports sustainable faculty development and contextually relevant educational innovation.The creation of a dynamic vCoP was instrumental in promoting shared ownership and collaboration,ultimately advancing competency-based,simulation-enhanced training in ophthalmology.These findings suggest similar team-based,technology-enabled strategies could strengthen training and patient care in other underserved settings and with other disciplines.展开更多
Introduction According to the latest statistics from the World Health Organization(WHO),pancreatic cancer is not one of the most common types of cancer,but only ranks 12th on the list of can-cers with the highest inci...Introduction According to the latest statistics from the World Health Organization(WHO),pancreatic cancer is not one of the most common types of cancer,but only ranks 12th on the list of can-cers with the highest incidence in the general worldwide popu-lation(510,992 new cases per year).[1]However,when analyzing the global mortality rate,the importance of this type of cancer increases considerably,as pancreatic cancer ranks sixth,with a rate of around 4.8%of all cancer deaths.[1]This apparent dis-crepancy between incidence and mortality is due to a variety of factors,including the lack of effective screening,diagnostic delays due to the appearance of(often non-specific)symptoms only at advanced stages of disease,high aggressive potential,rapid progression and spread,proximity to other vital structures and limited availability of treatment options due to invasiveness,anatomical location,and resistance to therapeutic treatments.展开更多
文摘Hemorrhoidal disease is a prevalent anorectal condition causing significant morbidity,affecting approximately 4%of the general population with incidence increasing with age and sedentary lifestyle.While conventional excisional hemorrhoidectomy techniques such as Milligan-Morgan and Ferguson remain standard for long-term efficacy,they are often associated with substantial postoperative pain and prolonged recovery.This narrative review evaluates the comparative clinical outcomes of laser hemorrhoidoplasty(LHP)versus conventional surgical interventions in the treatment of grade II and III symptomatic hemorrhoids.A comprehensive analysis of comparative studies,randomized controlled trials,and meta-analyses published between 2020 and 2025 was conducted,with primary outcomes including postoperative pain,recovery time,operative duration,complication rates,and recurrence.Key findings from studies by Maloku et al and Hassan et al.were analyzed to contextualize real-world LHP use.Across multiple high-quality studies,LHP was consistently associated with significantly lower postoperative pain scores,reduced analgesic requirements,and faster return to daily activities.Maloku et al demonstrated a shorter mean operative time(15.9 minutes)and reduced pain compared to open techniques(26.8 minutes;P<0.01).Hassan et al confirmed these benefits in a cohort of 40 patients treated under local anesthesia.Operative time was generally comparable or shorter,and vessel ligation was suggested as an adjunct to improve outcomes in select cases.Complication rates were low and similar between groups,with LHP demonstrating minimal risk for major complications such as anal stenosis or incontinence.However,recurrence rates were higher with LHP in some studies,particularly in grade III disease.LHP offers a minimally invasive,low-morbidity alternative to excisional hemorrhoidectomy for appropriately selected patients.Despite superior short-term recovery profiles,potential for higher recurrence underscores the importance of patient selection and long-term follow-up.The role of local anesthesia and adjunctive vessel ligation merits further prospective evaluation.
文摘1.Biochemical structure and molecular activity of meldonium Meldonium(commercial name Mildronate)was originally synthesized in the mid-1970s at the Institute of Organic Synthesis of the Latvian Soviet Socialist Republic Academy of Sciences.The chemical structure of this compound(3-(2,2,2-
文摘BACKGROUND The scientific literature provides evidence that nutritional ketosis can be an important support in the treatment of pathologies in which inflammation is present,as recent studies have shown that ketone bodies have anti-inflammatory activity in numerous diseases,including rheumatic diseases.We report the case of a 22-year-old woman with class I obesity and juvenile idiopathic arthritis who started treatment with a very low calorie ketogenic diet(VLCKD).CASE SUMMARY The patient was a 22-year-old woman diagnosed with juvenile idiopathic arthritis at age 4 years and with a body mass index(BMI)of 30.8 kg/m2,waist circumference(WC)80 cm,fat mass(FM)28.1 kg,free FM 45.7 kg,and visceral adipose tissue(VAT)3.5 kg,assessed on bioimpedance analysis.She was treated using a commercial VLCKD weight-loss program(PNK®method);this program provides high-biological-value protein preparations and natural foods.Each protein preparation contains 15 g protein,4 g carbohydrate,3 g fat,and 50 mg omega-3 docosahexaenoic acid,with an energy content of 90–120 kcal.After four months on the program,the BMI was 28.6 kg/m2,WC 73 cm,FM 23.2 kg,free FM 41.9 kg,and VAT 2.9 kg.CONCLUSION VLCKD enabled the patient to reach her target weight and to reduce her joint pain and headaches.Laboratory inflammatory indices also normalized.
文摘Background:This study was planned to assess the accuracy and comparability of two commercially available,laboratory-based SARS-CoV-2(severe acute respiratory syndrome)antigen(Ag)immunoassays.Methods:We studied a cohort of subjects with acute SARS-CoV-2 infection,from whom a nasopharyngeal swab was taken and tested with a molecular assay(Altona Diagnostics RealStar SARS-CoV-2 RT-PCR Kit)and two laboratory-based,fully automated SARS-CoV-2 Ag immunoassays(Fujirebio Lumipulse G SARS-CoV-2 Ag and Roche Elecsys SARS-CoV-2 Ag).Results:The final population consisted in 93 subjects testing positive for SARS-CoV-2 RNA,34 with cycle threshold(Ct)values<29.5.The results of the two SARS-CoV-2 Ag immunoassays were significantly intercorrelated(r=0.77;P<0.001)in the entire cohort,though such correlation considerably improved in patients with high viral load(cycle threshold values<29.5:r=0.96;P<0.001).The accuracy for identifying samples with high viral load was excellent for both Lumipulse G SARS-CoV-2 Ag(AUC,0.99;P<0.001)and Elecsys SARS-CoV-2 Ag(AUC,0.99;P<0.001),with best cut-offs of 2.03 ng/mL for Lumipulse G SARS-CoV-2 Ag(1.00 sensitivity and 0.88 specificity)and 0.70 COI for Elecsys SARS-CoV-2 Ag(1.00 sensitivity and 0.80 specificity),respectively.Conclusion:The results of this study provide valuable support to usability of fully-automated,rapid,high throughput and accurate SARS-CoV-2 Ag immunoassays for complementing molecular assays.
文摘Background:Health professions education(HPE)in underserved and resource-constrained regions faces persistent challenges,including limited faculty development opportunities and the absence of context-specific curricula.The growing need to increase access to cataract surgery and reduce avoidable blindness underscores the urgency of training more competent cataract surgeons.Developing a standardized,nationally endorsed,outcome-based curriculum for simulation-based training in cataract surgery represents a strategic solution.This study explores integrating online active and constructivist social learning strategies within team projects to address these educational gaps,emphasizing equitable international partnerships between experienced global ophthalmological societies(GOS)in HPE,and national ophthalmological societies(NOS)especially in underserved regions.Methods:We conducted an non-experimental investigation involving the Mozambican College of Ophthalmology(NOS),comprising ten senior ophthalmologist educators,including the President(A.B.),each with over ten years of postgraduate teaching leadership experience.To promote inclusivity and foster future leadership,six early-career ophthalmologists with under five years of experience were invited to join.The GOS was represented by two ophthalmologist educators(K.G.and H.P.F.)affiliated with the Ophthalmology Foundation and experienced in international HPE.Together,both organizations formed an equitable and culturally adapted partnership,led by the NOS,to co-design an outcome-based curriculum for cataract surgery simulation training.The collaborative process used a group mentor-facilitated model integrating design thinking,and social constructivist strategies.A virtual community of practice(vCoP),sustained through WhatsApp,enabled continuous peer support and knowledge exchange.The project spanned eight monthly 90-minute videoconferences via Zoom,incorporating online group mentoring and a virtual jigsaw exercise.Results:The collaboration resulted in the development of a competency-based,simulation-enhanced small incision cataract surgery curriculum structured around the Ophthalmic Simulated Surgical Competency Assessment Rubric(Sim-OSSCAR).The curriculum followed Kern’s six-step framework and was organized into four modular components covering the full range of surgical steps.The vCoP emerged as a key platform for sustained faculty development,collaborative problem-solving,and shared expertise,enhancing institutional capacity within the NOS.Participants anecdotally reported increased confidence in curriculum design,strengthened mentoring relationships,and greater engagement through active learning methodologies.The model demonstrated scalability and adaptability,indicating potential for broader application across other medical specialties and contexts.Conclusions:This study highlights the transformative potential of combining design thinking,active and social learning strategies,and digital tools in HPE.By fostering equitable,structured international collaborations,this approach supports sustainable faculty development and contextually relevant educational innovation.The creation of a dynamic vCoP was instrumental in promoting shared ownership and collaboration,ultimately advancing competency-based,simulation-enhanced training in ophthalmology.These findings suggest similar team-based,technology-enabled strategies could strengthen training and patient care in other underserved settings and with other disciplines.
文摘Introduction According to the latest statistics from the World Health Organization(WHO),pancreatic cancer is not one of the most common types of cancer,but only ranks 12th on the list of can-cers with the highest incidence in the general worldwide popu-lation(510,992 new cases per year).[1]However,when analyzing the global mortality rate,the importance of this type of cancer increases considerably,as pancreatic cancer ranks sixth,with a rate of around 4.8%of all cancer deaths.[1]This apparent dis-crepancy between incidence and mortality is due to a variety of factors,including the lack of effective screening,diagnostic delays due to the appearance of(often non-specific)symptoms only at advanced stages of disease,high aggressive potential,rapid progression and spread,proximity to other vital structures and limited availability of treatment options due to invasiveness,anatomical location,and resistance to therapeutic treatments.
