Vasospastic angina(VSA)is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis.It...Vasospastic angina(VSA)is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis.It is an underdiagnosed and often challenging condition that can lead to recurrent angina,myocardial infarction,and sudden cardiac death.VSA arises from a multifactorial interplay of endothelial dysfunction,vascular smooth muscle hyperreactivity,inflammation,and autonomic dysregulation.While calcium channel blockers and nitrates remain the mainstay of therapy,there is a growing body of evidence in the use of novel and emerging treatments including Rho-kinase inhibitors,endothelin receptor antagonists,and anti-inflammatory agents for refractory cases.Diagnostic evaluation relies on clinical features and,when necessary,invasive coronary pharmacological provocation testing.This narrative review examines the current understanding of VSA,discusses current international guideline-based diagnostic and therapeutic strategies,and highlights novel and investigational approaches that may broaden the treatment armamentarium against it.展开更多
1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside s...1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside surgery,chemotherapy,radiotherapy,and immunotherapy^([2]).As theranostics continues to evolve,it is essential for clinicians and radiologists to be aware of the cur-rent landscape and trends in the field^([3-5]).This article aims to highlight the importance for global radiology training colleges to formally introduce theranostics into their training curricula.This is to ensure that their trainees will gain adequate exposure to this growing branch of precision medicine and to enable them to contribute effectively to the field of oncology.展开更多
BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pa...BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.展开更多
Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, ...Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.展开更多
Floseal Hemostatic Matrix is a topical hemostatic agent used across specialties and commonly applied to the renal bed during partial nephrectomy.Here we present the first adult case of Floseal allergy in the literatur...Floseal Hemostatic Matrix is a topical hemostatic agent used across specialties and commonly applied to the renal bed during partial nephrectomy.Here we present the first adult case of Floseal allergy in the literature.A 62-year-old man underwent partial nephrectomy for a Bosniak type Ⅳ cyst.After unclamping the kidney,the patient declined precipitously,later determined due to an anaphylactic reaction to the Floseal placed on the renal bed.The patient had a prolonged anaphylactic reaction that required ionotropic support for over 24 h,possibly due to continued exposure.His tryptase level was elevated,and allergy testing revealed an allergy to the gelatin matrix component of the Floseal.Floseal anaphylaxis should be considered during episodes of cardiovascular collapse after drug administration.However,consideration should be given to removing it to prevent continued exposure and weighed against the risk of prolonged surgery in an anaphylactic patient.展开更多
The integration of artificial intelligence(AI)into plastic surgery is transforming the field by enhancing precision in preoperative planning,diagnostic accuracy,intraoperative assistance,and postoperative care.AI enco...The integration of artificial intelligence(AI)into plastic surgery is transforming the field by enhancing precision in preoperative planning,diagnostic accuracy,intraoperative assistance,and postoperative care.AI encompasses machine learning,natural language processing,computer vision,and artificial neural networks,each offering unique advancements to surgical practice.This narrative review explores the ethical challenges of AI in plastic surgery,addressing concerns such as data protection,algorithmic bias,transparency,accountability,and informed consent.A comprehensive search adhering to PRISMA guidelines identified 63 studies,with 15 selected for in-depth analysis.Findings indicate significant ethical issues:data privacy needs stringent cybersecurity,biases in AI models must be mitigated,and transparency in AI decision making is essential.The review emphasizes the necessity for updated Health Insurance Portability and Accountability Act(HIPAA)regulations,robust validation mechanisms,and the development of explainable AI models.It also highlights the need for an independent regulatory body to oversee AI integration,ensuring ethical standards and protecting patient welfare.Although AI presents promising benefits,its successful application in plastic surgery hinges on addressing these ethical challenges comprehensively.展开更多
The increasing adoption and widespread acceptance of negative pressure wound therapy(NPWT)have paralleled the expansion of its indications in clinical practice.The spectrum of indications for NPWT now extends to encom...The increasing adoption and widespread acceptance of negative pressure wound therapy(NPWT)have paralleled the expansion of its indications in clinical practice.The spectrum of indications for NPWT now extends to encompass soft tissue defects arising from trauma,infection,surgical wound care,and soft tissue grafting procedures.Recent advancements in NPWT devices have introduced various adjuncts,such as instillation of fluids or antibiotics into the wound.These additions empower surgeons to enhance the wound healing environment and contribute to combatting infections more effectively.This review delves into the latest literature addressing the proposed mechanisms underlying NPWT's action,its cost-effectiveness,its impact on patient quality of life,and the essential components necessary for its safe use.The review examines the evidence supporting NPWT's application in managing traumatic extremity injuries,controlling infections,and wound care.While NPWT generally exhibits a low complication rate,surgeons must remain aware of the potential risks linked to its utilization.Moreover,the review explores the widening scope of indications for NPWT,shedding light on prospective avenues for innovation and research in this field.展开更多
The introduction of generative artificial intelligence(AI)has revolutionized healthcare and education.These AI systems,trained on vast datasets using advanced machine learning(ML)techniques and large language models(L...The introduction of generative artificial intelligence(AI)has revolutionized healthcare and education.These AI systems,trained on vast datasets using advanced machine learning(ML)techniques and large language models(LLMs),can generate text,images,and videos,offering new avenues for enhancing surgical education.Their ability to produce interactive learning resources,procedural guidance,and feedback post-virtual simulations makes them valuable in educating surgical trainees.However,technical challenges such as data quality issues,inaccuracies,and uncertainties around model interpretability remain barriers to widespread adoption.This review explores the integration of generative AI into surgical training,assessing its potential to enhance learning and teaching methodologies.While generative AI has demonstrated promise for improving surgical education,its integration must be approached cautiously,ensuring AI input is balanced with traditional supervision and mentorship from experienced surgeons.Given that generative AI models are not yet suitable as standalone tools,a blended learning approach that integrates AI capabilities with conventional educational strategies should be adopted.The review also addresses limitations and challenges,emphasizing the need for more robust research on different AI models and their applications across various surgical subspecialties.The lack of standardized frameworks and tools to assess the quality of AI outputs in surgical education necessitates rigorous oversight to ensure accuracy and reliability in training settings.By evaluating the current state of generative AI in surgical education,this narrative review highlights the potential for future innovation and research,encouraging ongoing exploration of AI in enhancing surgical education and training.展开更多
Three-dimensional(3D)printed models offer potential advantages over traditional teaching methods by providing realistic,tactile learning aids.The overall efficacy of 3D printing in plastic surgery education has not be...Three-dimensional(3D)printed models offer potential advantages over traditional teaching methods by providing realistic,tactile learning aids.The overall efficacy of 3D printing in plastic surgery education has not been previously systematically analysed.A review of PubMed,Web of Science,and Embase databases up to October 2023 identified studies using 3D printed models in plastic surgery education.Inclusion criteria were set to select before-after studies or studies comparing 3D printed models to traditional teaching methods.Outcome measures included Likert scales,Multiple choice quest tests or other scoring systems.37 studies met the inclusion criteria.Learners demonstrated enhanced anatomical understanding and procedural knowledge after engaging with 3D models.The comparative studies included in the review further highlight the superiority of 3D models over traditional learning tools,with average increases in test scores and procedural confidence,quantified through Likert scales and multiple-choice questionnaires.Ultimately,the findings of this review suggest that 3D printing enhances learning,making educational experiences more interactive and effective than traditional methods.While costs,accessibility,and a lack of technical expertise may pose challenges,integrating 3D models into training could enhance plastic surgical education.High-quality randomized controlled trials are necessary to confirm these findings and standardise outcomes for broader applications.展开更多
This study evaluated three prominent Large Language Models(LLMs)-Google’s AI BARD,Bing’s AI,and ChatGPT-4 in providing patient advice for hand laceration.Five simulated patient inquiries on hand trauma were prompted...This study evaluated three prominent Large Language Models(LLMs)-Google’s AI BARD,Bing’s AI,and ChatGPT-4 in providing patient advice for hand laceration.Five simulated patient inquiries on hand trauma were prompted to them.A panel of Board-certified plastic surgical residents evaluated the responses for accuracy,comprehensiveness,and appropriate sources.Responses were also compared against existing literature and guidelines.This study suggests that ChatGPT outperforms BARD and Bing AI in providing reliable,evidence-based clinical advice,but they still face limitations in depth and specificity.Healthcare professionals are essential in interpreting LLM recommendations,and future research should improve LLM performance by integrating specialized databases and human expertise to advance nerve injury management and optimize patient-centred care.展开更多
文摘Vasospastic angina(VSA)is a distinct endotype of ischemia with non-obstructive coronary arteries characterized by transient coronary artery spasm and myocardial ischemia in the absence of significant fixed stenosis.It is an underdiagnosed and often challenging condition that can lead to recurrent angina,myocardial infarction,and sudden cardiac death.VSA arises from a multifactorial interplay of endothelial dysfunction,vascular smooth muscle hyperreactivity,inflammation,and autonomic dysregulation.While calcium channel blockers and nitrates remain the mainstay of therapy,there is a growing body of evidence in the use of novel and emerging treatments including Rho-kinase inhibitors,endothelin receptor antagonists,and anti-inflammatory agents for refractory cases.Diagnostic evaluation relies on clinical features and,when necessary,invasive coronary pharmacological provocation testing.This narrative review examines the current understanding of VSA,discusses current international guideline-based diagnostic and therapeutic strategies,and highlights novel and investigational approaches that may broaden the treatment armamentarium against it.
文摘1|Introduction Theranostics is quickly establishing itself as a key component in the field of cancer diagnosis and treatment^([1]).It is now considered the fifth pillar of contemporary oncology manage-ment alongside surgery,chemotherapy,radiotherapy,and immunotherapy^([2]).As theranostics continues to evolve,it is essential for clinicians and radiologists to be aware of the cur-rent landscape and trends in the field^([3-5]).This article aims to highlight the importance for global radiology training colleges to formally introduce theranostics into their training curricula.This is to ensure that their trainees will gain adequate exposure to this growing branch of precision medicine and to enable them to contribute effectively to the field of oncology.
文摘BACKGROUND The World Health Organisation declared the coronavirus disease 2019(COVID-19)a pandemic on March 11,2020.While globally,the relative caseload has been high,Australia’s has been relatively low.During the pandemic,radiology services have seen significant changes in workflow across modalities and a reduction in imaging volumes.AIM To investigate differences in modality imaging volumes during the COVID-19 pandemic across a large Victorian public health network.METHODS A retrospective analysis from January 2019 to December 2020 compared imaging volumes across two periods corresponding to the pandemic’s first and second waves.Weekly volumes across patient class,modality and mobile imaging were summed for periods:wave 1(weeks 11 to 16 for 2019;weeks 63 to 68 for 2020)and wave 2(weeks 28 to 43 for 2019;weeks 80 to 95 for 2020).Microsoft Power Business Intelligence linked to the radiology information system was used to mine all completed examinations.RESULTS Summed weekly data during the pandemic’s first wave showed the greatest decrease of 29.8%in adult outpatient imaging volumes and 46.3%in paediatric emergency department imaging volumes.Adult nuclear medicine demonstrated the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 47.8%,with angiography increasing by 50%.The pandemic’s second wave demonstrated the greatest decrease of 23.5%in adult outpatient imaging volumes,with an increase of 18.2%in inpatient imaging volumes.The greatest decrease was 28.5%in paediatric emergency department imaging volumes.Nuclear medicine showed the greatest decrease of 37.1%for the same period.Paediatric nuclear medicine showed the greatest decrease of 36.7%.Mobile imaging utilisation increased between 57.8%and 135.1%during the first and second waves.A strong correlation was observed between mobile and nonmobile imaging in the emergency setting(Spearman’s correlation coefficient=-0.743,P=0.000).No correlation was observed in the inpatient setting(Spearman’s correlation coefficient=-0.059,P=0.554).CONCLUSION Nuclear medicine was most impacted,while computed tomography and angiography were the least affected by the pandemic.The impact was less during the pandemic’s second wave.Mobile imaging shows continuous growth during both waves.
基金Supported by The Northcott Devon Medical FoundationThe NHS SW Researchand Development Fund
文摘Many premature babies, especially those with a low birth weight are given multiple transfusions during their first few weeks of life. The major serious complications of prematurity include bronchopulmonary dysplasia, with lesser incidences of retinopathy of prematurity, intraventricular haemorrhage, and necrotising enterocolitis. Many studies have shown correlations between the receipt of blood transfusions and the development of these conditions, but little is known of the underlying pathophysiology of this relationship. Recent studies are beginning to provide some answers. This review examines recent findings with regard to the influence of preparation and storage of paediatric packed red blood cell units on heme, iron, and oxidative status of the units and relates these to the ability of the premature baby to deal with these changes following the receipt of blood transfusions. Paediatric packed red blood cell units are a potential source of heme, redox active iron and free radicals, and this increases with storage age. Haemolysis of transfused red blood cells may add further iron and cell free haemoglobin to the recipient baby. Premature babies, particularly those with low birth weight and gestational age appear to have littlereserve to cope with any additional iron, heme and/or oxidative load. The consequences of these events are discussed with regard to their contribution to the major complications of prematurity and a novel hypothesis regarding transfusion-related morbidity in premature babies is presented. The review concludes with a discussion of potential means of limiting transfusion related iron/heme and oxidative load through the preparation and storage of packed red blood cell units and through modifications in clinical practice.
文摘Floseal Hemostatic Matrix is a topical hemostatic agent used across specialties and commonly applied to the renal bed during partial nephrectomy.Here we present the first adult case of Floseal allergy in the literature.A 62-year-old man underwent partial nephrectomy for a Bosniak type Ⅳ cyst.After unclamping the kidney,the patient declined precipitously,later determined due to an anaphylactic reaction to the Floseal placed on the renal bed.The patient had a prolonged anaphylactic reaction that required ionotropic support for over 24 h,possibly due to continued exposure.His tryptase level was elevated,and allergy testing revealed an allergy to the gelatin matrix component of the Floseal.Floseal anaphylaxis should be considered during episodes of cardiovascular collapse after drug administration.However,consideration should be given to removing it to prevent continued exposure and weighed against the risk of prolonged surgery in an anaphylactic patient.
文摘The integration of artificial intelligence(AI)into plastic surgery is transforming the field by enhancing precision in preoperative planning,diagnostic accuracy,intraoperative assistance,and postoperative care.AI encompasses machine learning,natural language processing,computer vision,and artificial neural networks,each offering unique advancements to surgical practice.This narrative review explores the ethical challenges of AI in plastic surgery,addressing concerns such as data protection,algorithmic bias,transparency,accountability,and informed consent.A comprehensive search adhering to PRISMA guidelines identified 63 studies,with 15 selected for in-depth analysis.Findings indicate significant ethical issues:data privacy needs stringent cybersecurity,biases in AI models must be mitigated,and transparency in AI decision making is essential.The review emphasizes the necessity for updated Health Insurance Portability and Accountability Act(HIPAA)regulations,robust validation mechanisms,and the development of explainable AI models.It also highlights the need for an independent regulatory body to oversee AI integration,ensuring ethical standards and protecting patient welfare.Although AI presents promising benefits,its successful application in plastic surgery hinges on addressing these ethical challenges comprehensively.
文摘The increasing adoption and widespread acceptance of negative pressure wound therapy(NPWT)have paralleled the expansion of its indications in clinical practice.The spectrum of indications for NPWT now extends to encompass soft tissue defects arising from trauma,infection,surgical wound care,and soft tissue grafting procedures.Recent advancements in NPWT devices have introduced various adjuncts,such as instillation of fluids or antibiotics into the wound.These additions empower surgeons to enhance the wound healing environment and contribute to combatting infections more effectively.This review delves into the latest literature addressing the proposed mechanisms underlying NPWT's action,its cost-effectiveness,its impact on patient quality of life,and the essential components necessary for its safe use.The review examines the evidence supporting NPWT's application in managing traumatic extremity injuries,controlling infections,and wound care.While NPWT generally exhibits a low complication rate,surgeons must remain aware of the potential risks linked to its utilization.Moreover,the review explores the widening scope of indications for NPWT,shedding light on prospective avenues for innovation and research in this field.
文摘The introduction of generative artificial intelligence(AI)has revolutionized healthcare and education.These AI systems,trained on vast datasets using advanced machine learning(ML)techniques and large language models(LLMs),can generate text,images,and videos,offering new avenues for enhancing surgical education.Their ability to produce interactive learning resources,procedural guidance,and feedback post-virtual simulations makes them valuable in educating surgical trainees.However,technical challenges such as data quality issues,inaccuracies,and uncertainties around model interpretability remain barriers to widespread adoption.This review explores the integration of generative AI into surgical training,assessing its potential to enhance learning and teaching methodologies.While generative AI has demonstrated promise for improving surgical education,its integration must be approached cautiously,ensuring AI input is balanced with traditional supervision and mentorship from experienced surgeons.Given that generative AI models are not yet suitable as standalone tools,a blended learning approach that integrates AI capabilities with conventional educational strategies should be adopted.The review also addresses limitations and challenges,emphasizing the need for more robust research on different AI models and their applications across various surgical subspecialties.The lack of standardized frameworks and tools to assess the quality of AI outputs in surgical education necessitates rigorous oversight to ensure accuracy and reliability in training settings.By evaluating the current state of generative AI in surgical education,this narrative review highlights the potential for future innovation and research,encouraging ongoing exploration of AI in enhancing surgical education and training.
文摘Three-dimensional(3D)printed models offer potential advantages over traditional teaching methods by providing realistic,tactile learning aids.The overall efficacy of 3D printing in plastic surgery education has not been previously systematically analysed.A review of PubMed,Web of Science,and Embase databases up to October 2023 identified studies using 3D printed models in plastic surgery education.Inclusion criteria were set to select before-after studies or studies comparing 3D printed models to traditional teaching methods.Outcome measures included Likert scales,Multiple choice quest tests or other scoring systems.37 studies met the inclusion criteria.Learners demonstrated enhanced anatomical understanding and procedural knowledge after engaging with 3D models.The comparative studies included in the review further highlight the superiority of 3D models over traditional learning tools,with average increases in test scores and procedural confidence,quantified through Likert scales and multiple-choice questionnaires.Ultimately,the findings of this review suggest that 3D printing enhances learning,making educational experiences more interactive and effective than traditional methods.While costs,accessibility,and a lack of technical expertise may pose challenges,integrating 3D models into training could enhance plastic surgical education.High-quality randomized controlled trials are necessary to confirm these findings and standardise outcomes for broader applications.
文摘This study evaluated three prominent Large Language Models(LLMs)-Google’s AI BARD,Bing’s AI,and ChatGPT-4 in providing patient advice for hand laceration.Five simulated patient inquiries on hand trauma were prompted to them.A panel of Board-certified plastic surgical residents evaluated the responses for accuracy,comprehensiveness,and appropriate sources.Responses were also compared against existing literature and guidelines.This study suggests that ChatGPT outperforms BARD and Bing AI in providing reliable,evidence-based clinical advice,but they still face limitations in depth and specificity.Healthcare professionals are essential in interpreting LLM recommendations,and future research should improve LLM performance by integrating specialized databases and human expertise to advance nerve injury management and optimize patient-centred care.
