Insulinomas are the most frequent type of functional pancreatic neuroendocrine tumors with a variety of neuroglycopenic and autonomic symptoms and welldefined diagnostic criteria;however,prediction of their clinical b...Insulinomas are the most frequent type of functional pancreatic neuroendocrine tumors with a variety of neuroglycopenic and autonomic symptoms and welldefined diagnostic criteria;however,prediction of their clinical behavior and early differentiation between benign and malignant lesions remain a challenge.The comparative studies between benign and malignant cases are limited,suggesting that short clinical history,early hypoglycemia during fasting,high proinsulin,insulin,and C-peptide concentrations raise suspicion of malignancy.Indeed,malignant tumors are larger with higher mitotic count and Ki-67 proliferative activity,but there are no accurate histological criteria to distinguish benign from malignant forms.Several signaling pathways have been suggested to affect the pathophysiology and behavior of insulinomas;however,our knowledge is limited,urging a further understanding of molecular genetics.Therefore,there is a need for the identification of reliable markers of metastatic disease that could also serve as therapeutic targets in patients with malignant insulinoma.This opinion review reflects on current gaps in diagnostic and clinical aspects related to the malignant behavior of insulinoma.展开更多
The zoonotic risk of hepatitis E virus(HEV)is well established.The HEV seroprevalence rates vary according to geographical region,assays used,and study cohorts.HEV infection is still underdiagnosed,implying the need t...The zoonotic risk of hepatitis E virus(HEV)is well established.The HEV seroprevalence rates vary according to geographical region,assays used,and study cohorts.HEV infection is still underdiagnosed,implying the need to evaluate the disease's burden in the general population and specific risk groups,such as professionally exposed.Close contact with various animal reservoirs such as pigs,rabbits,sheep,dogs,wild boars,and deer has been associated with higher anti-HEV seroprevalence as a part of occupational exposure.While exact transmission routes remain to be determined,some general preventive measures such as proper hand hygiene,the usage of personal protective equipment,and the thermal processing of food before consumption should be followed.A“One-Health”multisectoral approach should be implemented to achieve optimal health and well-being outcomes,recognizing the interconnections between humans,animals,plants,and their shared environment,in which a vaccine against the zoonotic genotypes 3 and 4 and swine vaccination should be considered as a possible public health measure.This opinion review comprehensively addresses the HEV burden of professional exposure for butchers,slaughterhouse workers,veterinarians,farmers,hunters,and forestry workers delineates the current limits of protective work measures,and tackles future directions.展开更多
Computed tomography colonography(CTC)has become a key examination in detecting colonic polyps and colorectal carcinoma(CRC).It is particularly useful after incomplete optical colonoscopy(OC)for patients with sedation ...Computed tomography colonography(CTC)has become a key examination in detecting colonic polyps and colorectal carcinoma(CRC).It is particularly useful after incomplete optical colonoscopy(OC)for patients with sedation risks and patients anxious about the risks or potential discomfort associated with OC.CTC's main advantages compared with OC are its non-invasive nature,better patient compliance,and the ability to assess the extracolonic disease.Despite these advantages,ionizing radiation remains the most significant burden of CTC.This opinion review comprehensively addresses the radiation risk of CTC,incorporating imaging technology refinements such as automatic tube current modulation,filtered back projections,lowering the tube voltage,and iterative reconstructions as tools for optimizing low and ultra-low dose protocols of CTC.Future perspectives arise from integrating artificial intelligence in computed tomography machines for the screening of CRC.展开更多
The microbiome's role in transplantation has received growing interest,but the role of virome remains understudied.Pegiviruses are single-stranded positivesense RNA viruses,historically associated with liver disea...The microbiome's role in transplantation has received growing interest,but the role of virome remains understudied.Pegiviruses are single-stranded positivesense RNA viruses,historically associated with liver disease,but their pathogenicity is controversial.In the transplantation setting,pegivirus infection does not seem to have a negative impact on the outcomes of solid-organ and hematopoietic stem cell transplant recipients.However,the role of pegiviruses as proxies in immunosuppression monitoring brings novelty to the field of virome research in immunocompromised individuals.The possible immunomodulatory effect of pegivirus infections remains to be elucidated in further trials.展开更多
文摘Insulinomas are the most frequent type of functional pancreatic neuroendocrine tumors with a variety of neuroglycopenic and autonomic symptoms and welldefined diagnostic criteria;however,prediction of their clinical behavior and early differentiation between benign and malignant lesions remain a challenge.The comparative studies between benign and malignant cases are limited,suggesting that short clinical history,early hypoglycemia during fasting,high proinsulin,insulin,and C-peptide concentrations raise suspicion of malignancy.Indeed,malignant tumors are larger with higher mitotic count and Ki-67 proliferative activity,but there are no accurate histological criteria to distinguish benign from malignant forms.Several signaling pathways have been suggested to affect the pathophysiology and behavior of insulinomas;however,our knowledge is limited,urging a further understanding of molecular genetics.Therefore,there is a need for the identification of reliable markers of metastatic disease that could also serve as therapeutic targets in patients with malignant insulinoma.This opinion review reflects on current gaps in diagnostic and clinical aspects related to the malignant behavior of insulinoma.
文摘The zoonotic risk of hepatitis E virus(HEV)is well established.The HEV seroprevalence rates vary according to geographical region,assays used,and study cohorts.HEV infection is still underdiagnosed,implying the need to evaluate the disease's burden in the general population and specific risk groups,such as professionally exposed.Close contact with various animal reservoirs such as pigs,rabbits,sheep,dogs,wild boars,and deer has been associated with higher anti-HEV seroprevalence as a part of occupational exposure.While exact transmission routes remain to be determined,some general preventive measures such as proper hand hygiene,the usage of personal protective equipment,and the thermal processing of food before consumption should be followed.A“One-Health”multisectoral approach should be implemented to achieve optimal health and well-being outcomes,recognizing the interconnections between humans,animals,plants,and their shared environment,in which a vaccine against the zoonotic genotypes 3 and 4 and swine vaccination should be considered as a possible public health measure.This opinion review comprehensively addresses the HEV burden of professional exposure for butchers,slaughterhouse workers,veterinarians,farmers,hunters,and forestry workers delineates the current limits of protective work measures,and tackles future directions.
文摘Computed tomography colonography(CTC)has become a key examination in detecting colonic polyps and colorectal carcinoma(CRC).It is particularly useful after incomplete optical colonoscopy(OC)for patients with sedation risks and patients anxious about the risks or potential discomfort associated with OC.CTC's main advantages compared with OC are its non-invasive nature,better patient compliance,and the ability to assess the extracolonic disease.Despite these advantages,ionizing radiation remains the most significant burden of CTC.This opinion review comprehensively addresses the radiation risk of CTC,incorporating imaging technology refinements such as automatic tube current modulation,filtered back projections,lowering the tube voltage,and iterative reconstructions as tools for optimizing low and ultra-low dose protocols of CTC.Future perspectives arise from integrating artificial intelligence in computed tomography machines for the screening of CRC.
基金Supported by the Croatian Science Foundation,Emerging and Neglected Hepatotropic Viruses after Solid Organ and Hematopoietic Stem Cell Transplantation,No.IP-2020-02-7407.
文摘The microbiome's role in transplantation has received growing interest,but the role of virome remains understudied.Pegiviruses are single-stranded positivesense RNA viruses,historically associated with liver disease,but their pathogenicity is controversial.In the transplantation setting,pegivirus infection does not seem to have a negative impact on the outcomes of solid-organ and hematopoietic stem cell transplant recipients.However,the role of pegiviruses as proxies in immunosuppression monitoring brings novelty to the field of virome research in immunocompromised individuals.The possible immunomodulatory effect of pegivirus infections remains to be elucidated in further trials.
