Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management.In addition,dis...Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management.In addition,distinguishing XGC from gallbladder cancer preoperatively is still a challenge.The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC.Data sources:The present systematic review was designed using the PRISMA and AMSTAR guidelines.We searched MEDLINE,Scopus,Clinicaltrials.gov,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar databases from inception until June 2020.Results:The laparoscopic cholecystectomy rate(34%)was almost equal to the open cholecystectomy rate(47%)for XGC.An important conversion rate(35%)was observed as well.The XGC cases treated by surgery were associated with low mortality(0.3%),limited intraoperative blood loss(58-270 m L),low complication rates(2%–6%),along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy)and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy).Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome.In addition,complex surgical procedures,like wedge hepatic resections and bile duct excision were required during operations for XGC.Conclusions:XGC seemed to be a rare,benign inflammatory disease that presents similar features as gallbladder cancer.The mortality and complication rates of XGC were low,despite the complex surgical procedures that might be required in some cases.展开更多
Osteoarthritis is a slowly progressive disease which includes the intervention of several cytokines, macrophage metalleinoproteinases reaction, leading to the degradation of the local cartilage but also having an impa...Osteoarthritis is a slowly progressive disease which includes the intervention of several cytokines, macrophage metalleinoproteinases reaction, leading to the degradation of the local cartilage but also having an impact on the serum acute phase proteins(APPs). Subsequently, biomarkers seem to be essential to estimate its progression and the need for any surgical intervention such as total arthroplasty, but also can be used as therapeutic agents. Recently, among APPs, fetuin A drew attention regarding its possible anti-inflammatory role in animal models but also as a therapeutic agent in the inflammatory joint disease in clinical trials. In contrast with other APPs such as C-reactive protein, fetuin A appears to be lower in the serum of patients with degenerative joint disease in comparison with the healthy ones, and also acts as an antagonist of the anti-proliferative potential of transforming growth factor-b(TGF-b) cytokines. Because of its lower serum levels in arthritis, an unregulated binding of TGF-b and bone morphogenetic proteins takes place leading to further arthritic lesions. The purpose of the present review is to assess the current evidence regarding the multipotent role of the alpha-2-HSglycoprotein or as also known Fetuin-a in animal models but also as a biomarker of the degenerative joint arthritis in clinical trials.展开更多
AIM To investigate the association of psychiatric and psychosocial correlates with inflammatory bowel disease(IBD) activity in children and adolescents.METHODS A total of 85 pediatric IBD patients(in remission or acti...AIM To investigate the association of psychiatric and psychosocial correlates with inflammatory bowel disease(IBD) activity in children and adolescents.METHODS A total of 85 pediatric IBD patients(in remission or active state of the disease) and their parents completed a series of questionnaires and semi-structured interviews measuring life events,depression,anxiety,family dysfunction,and parent mental health.Differences between the remission and the IBD active group and the association of any significant variable with the disease activity state were examined.RESULTS Parents of children being in active state of the disease reported more life events(P = 0.005) and stressful life events(P = 0.048) during the past year and more mental health symptoms(P < 0.001),while the childrenthemselves reported higher levels of anxiety symptoms(P = 0.017) compared to the remission group.In the logistic regression multivariate analysis,the only predictor which had a significant positive effect on the probability of the patients being in active state was parent mental health symptoms(OR = 4.8;95%CI:1.2-25.8).CONCLUSION Life events,child anxiety and parent mental health symptoms may be important correlates of pediatric IBD activity and targets of thorough assessment and treatment.展开更多
Alcohol use disorder(AUD)represents a major public health issue which affects millions of people globally and consist a chronic relapsing condition associated with substantial morbidity and mortality.The gut microbiom...Alcohol use disorder(AUD)represents a major public health issue which affects millions of people globally and consist a chronic relapsing condition associated with substantial morbidity and mortality.The gut microbiome plays a crucial role in maintaining overall health and has emerged as a significant contributor to the pathophysiology of various psychiatric disorders.Recent evidence suggests that the gut microbiome is intimately linked to the development and progression of AUD,with alcohol consumption directly impacting its composition and function.This review article aims to explore the intricate relationship between the gut microbiome and AUD,focusing on the implications for mental health outcomes and potential therapeutic strategies.We discuss the bidirectional communication between the gut microbiome and the brain,highlighting the role of microbiotaderived metabolites in neuroinflammation,neurotransmission,and mood regulation.Furthermore,we examine the influence of AUD-related factors,such as alcohol-induced gut dysbiosis and increased intestinal permeability,on mental health outcomes.Finally,we explore emerging therapeutic avenues targeting the gut microbiome in the management of AUD,including prebiotics,probiotics,and fecal microbiota transplantation.Understanding the complex interplay between the gut microbiome and AUD holds promise for developing novel interventions that could improve mental health outcomes in individuals with AUD.展开更多
Advances in intraocular lens(IOL)design have rendered cataract surgery a refractive procedure.Newer IOL types include bifocal,trifocal and extended depth of focus(EDOF)IOLs.Their basic difference nestles in the number...Advances in intraocular lens(IOL)design have rendered cataract surgery a refractive procedure.Newer IOL types include bifocal,trifocal and extended depth of focus(EDOF)IOLs.Their basic difference nestles in the number of focal points that each lens provides,which in turn leads to different visual outcomes.Familiarity of surgeons with the various characteristics of each lens is of utmost importance for accurate IOL selection to match each patient’s needs.In this review,we aim to compare the clinical outcomes after implantation of multifocal and EDOF IOLs in terms of distance,intermediate and near vision,contrast sensitivity,and reading performance.Finally,we discuss the defocus curve and the optical and photic phenomena associated with each type of IOL.展开更多
Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controv...Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controversial.There are two options for treatment:Immediate operative management and nonoperative management with antibiotics and/or drainage of any abscess or phlegmon.Each method of treatment has advantages and disadvantages.Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events.In many cases,non-operative management with or without drainage and interval appendectomy is advised.The reasons for this approach include new medications and policies for the use of antibiotic therapy.Furthermore,advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries.However,questions have been raised about the risk of recurrence,prolonged use of antibiotics,lengthened hospital stay and delay in returning to daily activities.Moreover,the need for interval appendectomy is currently under debate because of the low risk of recurrence.Due to the paucity of high-quality studies,more randomized controlled trials to determine the precise management strategy are needed.This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.展开更多
AIM: To evaluate the agreement of biomechanically corrected intraocular pressure(b-IOP) and central corneal thickness(CCT) measurements obtained with the updated Corvis ST tonometer versus Goldmann applanation tonomet...AIM: To evaluate the agreement of biomechanically corrected intraocular pressure(b-IOP) and central corneal thickness(CCT) measurements obtained with the updated Corvis ST tonometer versus Goldmann applanation tonometry(GAT) and optical-based corneal pachymetry(OB-CCT) in controls, patients with ocular hypertension(OHT) and primary open angle glaucoma(POAG).Additionally, we examined the differences in corneal deformation parameters provided by the updated Corvis ST among the three groups.METHODS: For each participant, GAT IOP, OB-CCT and measurements with a Corvis ST with updated software were obtained.Bland-Altman analysis was used to assess the agreement between the two measurement methods.RESULTS: A consecutive series of 80 eyes from 80 participants(30 with POAG, 25 with OHT and 25 normal controls) were included in this prospective study.The mean GAT IOP of all eyes was 17.2±3.6 mm Hg, and the mean b-IOP was 15.9±3.7 mm Hg(Spearman’s rho=0.767, P<0.001).The 95% limits of agreement(Lo As) ranged from-3.1 mm Hg to 5.5 mm Hg for GAT IOP and b-IOP.b-IOP was not correlated with OB-CCT(Spearman’s rho=-0.13 P=0.917).Meanwhile there was a weak positive corelation between OB-CCT and GAT IOP–b-IOP difference(Spearman’s rho=0.378, P=0.001).The mean OB-CCT was 549.5±36.4 μm, and the Corvis-CCT was 556.1±41.5 μm(Spearman’s rho=0.900, P<0.001).No statistically significant difference in the new indices provided by the updated Corvis ST was detected among the three groups.Compared with control eyes, POAG eyes had a significantly reduced applanation time 2 after adjusting for OB-CCT and GAT IOP(P=0.048).CONCLUSION: Corvis b-IOP and CCT correlate well with GAT IOP and OB-CCT.b-IOP is not affected by CCT, which might be an advantage, especially in thick or thin corneas.Corvis ST yields shorter applanation time 2 measurements in patients with POAG, which might reflect altered corneal viscoelasticity.展开更多
Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual,“hands-on”,rescuer-delivered chest compressions.The-theoretical-advantages include high-quality non-stop com...Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual,“hands-on”,rescuer-delivered chest compressions.The-theoretical-advantages include high-quality non-stop compressions,thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially“hazardous”victim,or from hazardous and/or difficult resuscitation conditions.Such circumstances involve cardiopulmonary resuscitation(CPR)in the Cardiac Catheterization Laboratory,especially directly under the fluoroscopy panel,where radiation is well known to cause detrimental effects to the rescuer,and CPR during/after land or air transportation of cardiac arrest victims.Lastly,CPR in a coronavirus disease 2019 patient/ward,where the danger of contamination and further serious illness of the health provider is very existent.The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these“hostile”and dangerous settings,while comparing them to manual compressions.展开更多
Type 2 diabetes mellitus(T2DM)is a leading risk factor for cardiovascular complications around the globe and one of the most common medical conditions.Atrial fibrillation(AF)is the most common supraventricular arrhyth...Type 2 diabetes mellitus(T2DM)is a leading risk factor for cardiovascular complications around the globe and one of the most common medical conditions.Atrial fibrillation(AF)is the most common supraventricular arrhythmia,with a rapidly increasing prevalence.T2DM has been closely associated with the risk of AF development,identified as an independent risk factor.Regarding cardiovascular complications,both AF and T2DM have been linked with high mortality.The underlying pathophysiology has not been fully determined yet;however,it is multifactorial,including structural,electrical,and autonomic pathways.Novel therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors,as well as antiarrhythmic strategies,such as cardioversion and ablation.Of interest,glucose-lowering therapies may affect the prevalence of AF.This review presents the current evidence regarding the connection between the two entities,the pathophysiological pathways that link them,and the therapeutic options that exist.展开更多
The global spread of the novel severe acute respiratory syndrome coronavirus 2 has had serious consequences in terms of patient morbidity and mortality and overburdened health care systems as well as the socioeconomic...The global spread of the novel severe acute respiratory syndrome coronavirus 2 has had serious consequences in terms of patient morbidity and mortality and overburdened health care systems as well as the socioeconomic implications.In the absence of effective therapies and vaccinations during the viral outbreak,the major and most concise means to control viral spread is spread prevention.Although information concerning the impact of severe acute respiratory syndrome coronavirus 2 on pediatric surgical patients has greatly expanded,relevant comprehensive studies are scarce.However,pandemic related morbidity has increased,while under normal circumstances mortality could have been minimized.展开更多
Pancreatic ductal adenocarcinoma(PDAC)is nowadays the fourth leading cause of cancer-related death worldwide,but according to recent estimations it will become the second leading cause of cancer-related deaths in the ...Pancreatic ductal adenocarcinoma(PDAC)is nowadays the fourth leading cause of cancer-related death worldwide,but according to recent estimations it will become the second leading cause of cancer-related deaths in the USA up to 2030,following lung cancer.The implementation of neoadjuvant chemotherapy during recent years led to an increase of overall survival at 35 months in PDAC after R0 resection[1].However,pancreatic cancer has a particularity that makes it a real challenge for clinicians:only 20%of patients are diagnosed early enough to have a resectable pancreatic cancer,whereas 40%of patients present with locally advanced or non-resectable disease,while the rest present with distant metastases[2].Systemic chemotherapy plays the main role in metastatic PDAC treatment:polychemotherapy regimens such as FOLFIRINOX(folinic acid,5-fluorouracil,irinotecan and oxaliplatin)or combination of gemcitabine/nab-paclitaxel seemed to improve median overall survival from 6.8 to 11.1 months and 6.7 to 8.5 months,respectively[3].展开更多
Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk o...Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk of transformation to lymphoma.Case presentation:A case report is described and review of the literature from January 1975 to January 2019 was performed.A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions.Incisional biopsy revealed BRLH.Oral doxycycline was initiated(100 mg two times a day)for a total of 2 months.Both lesions decreased in size significantly at the patient’s two-month follow up visit.The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years.The lesion in the left eye has remained stable in size after cessation of the oral doxycycline.A total of 235 cases of conjunctival BRLH were identified in our literature search.The mean age at diagnosis was 35.2 years(range,5 to 91 years).BRLH lesions were unilateral in 75%of patients and bilateral in 25%of them.Seven patients(2.9%)had a concurrent Epstein-Barr virus(EBV)infection at the time of lesion appearance.The most common treatments were surgical excision(155/235 or 65.9%)and corticosteroids(30/235 or 12.7%),while 14%(33/235)of the patients were observed and 4.6%(11/235)received external beam radiotherapy alone.Recurrence occurred in ten patients(10/235 or 4.2%),of whom five had undergone surgical excision alone,two excision followed by external beam radiotherapy,one excision and oral corticosteroids,one radiotherapy alone and one had been treated with topical corticosteroids.Overall,only 2 of the 235 reported cases(0.8%)developed malignancy,one localized to the conjunctiva and one systemic.Conclusions:Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa.Extensive literature review shows that most cases are treated with surgery,steroids or observation.Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions.BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.展开更多
Importance Vitamin A(or retinol)has considerable antioxidative and anti-inflammatory attributes and it may have protective effects on the respiratory health of patients with cystic fibrosis(CF).This issue,however,rema...Importance Vitamin A(or retinol)has considerable antioxidative and anti-inflammatory attributes and it may have protective effects on the respiratory health of patients with cystic fibrosis(CF).This issue,however,remains controversial.Objective The purpose of the present study was to investigate the relationship between serum retinol levels(SRL)and force expiratory volume in 1 second(FEV1)in patients with CF.Methods All patients with pancreatic insufficiency attending the CF Department of“Agia Sofia”Children’s Hospital in Athens,Greece,aged 6 to 19 years during the 2012–2016 period,who could perform spirometry effectively,were included in the study.The impact of SRL on FEV1 was examined longitudinally and analyzed with generalized estimating equations.Results The study included 231 patients and 851 SRL measurements were performed.In 25(3.2%)cases the SRL were below the 5th percentile of reference distribution;none was above the 95th percentile.The analysis showed that SRL was positively correlated with the FEV1(P<0.001).Interpretation In this sample of children and adolescents with CF,vitamin A deficiency was rare.Our results suggest a positive relationship between SRL and FEV1.展开更多
The classical cerebrospinal fluid biomarkers of Alzheimer's Disease (namely total tau, phospho-tau and amyloid beta peptide) have received much attention, since they can detect the biochemical fingerprint of Alzhe...The classical cerebrospinal fluid biomarkers of Alzheimer's Disease (namely total tau, phospho-tau and amyloid beta peptide) have received much attention, since they can detect the biochemical fingerprint of Alzheimer's disease and serve as a diagnostic aid for correct diagnosis of cognitive disorders during life. In this case series, we present 6 examples of patients with cognitive impairment of various types and severities and how biomarker data were helpful in every day diagnostic approach, combined with clinical, neuropsychological and imaging data and based on the most recent guidelines and recommendations.展开更多
Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,ca...Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,cardiac transplant patients exhibit worse cardiovascular prognosis,high mortality,and more admissions to the intensive care unit.In general,COVID-19 seems to deteriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure,especially in the presence of cardiovascular comorbidities such as diabetes mellitus,kidney dysfunction,and older age.COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury.Indeed,myocardial injury comprises a large category of detrimental effects for the myocardium,such as myocardial infarction type 1 or type 2,Takotsubo cardiomyopathy,microvascular dysfunction and myocarditis,which are not easily distinguished by HF.The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2,cytokine storm,hypercoagulation,inflammation,and endothelial dysfunction.The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.展开更多
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), is the most common cause of inherited cerebral small vessel disease, inherited stroke and inherited vascular dement...Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), is the most common cause of inherited cerebral small vessel disease, inherited stroke and inherited vascular dementia. It is not infrequent for CADASIL to be mistaken and mistreated for multiple sclerosis (MS). A much less frequent but existing scenario is the co-occurrence of CADASIL and MS (or MS-like inflammatory condition). Such patients may present with spinal cord lesions, brain or spinal cord enhancing lesions, positive oligoclonal bands and high IgG index in the cerebrospinal fluid and good response to corticosteroids or immunomodulating treatments. CADASIL through various mechanisms may trigger or modulate autoimmune reactions, and either be complicated by an inflammatory component or cause an MS-like disorder.展开更多
The core(established)cerebrospinal fluid biomarkers of Alzheimer's disease(AD),namely amyloid-beta peptide,total tau protein and phospho-tau protein,have become a part of the diagnostic workup of patients with cog...The core(established)cerebrospinal fluid biomarkers of Alzheimer's disease(AD),namely amyloid-beta peptide,total tau protein and phospho-tau protein,have become a part of the diagnostic workup of patients with cognitive disorders in many specialized centers,especially for ambiguous cases.Combined,these biomarkers can identify the presence or absence of an AD biochemical process with sensitivities and specificities approaching or exceeding 90%in both dementia and pre-dementia stages of AD.Thus,they have been incorporated in various sets of research or clinical diagnostic criteria and recommendations.Results that are atypical,incompatible with AD,or inconclusive may occur,necessitating the use of other cerebrospinal fluid or imaging biomarkers.展开更多
文摘Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management.In addition,distinguishing XGC from gallbladder cancer preoperatively is still a challenge.The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC.Data sources:The present systematic review was designed using the PRISMA and AMSTAR guidelines.We searched MEDLINE,Scopus,Clinicaltrials.gov,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar databases from inception until June 2020.Results:The laparoscopic cholecystectomy rate(34%)was almost equal to the open cholecystectomy rate(47%)for XGC.An important conversion rate(35%)was observed as well.The XGC cases treated by surgery were associated with low mortality(0.3%),limited intraoperative blood loss(58-270 m L),low complication rates(2%–6%),along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy)and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy).Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome.In addition,complex surgical procedures,like wedge hepatic resections and bile duct excision were required during operations for XGC.Conclusions:XGC seemed to be a rare,benign inflammatory disease that presents similar features as gallbladder cancer.The mortality and complication rates of XGC were low,despite the complex surgical procedures that might be required in some cases.
文摘Osteoarthritis is a slowly progressive disease which includes the intervention of several cytokines, macrophage metalleinoproteinases reaction, leading to the degradation of the local cartilage but also having an impact on the serum acute phase proteins(APPs). Subsequently, biomarkers seem to be essential to estimate its progression and the need for any surgical intervention such as total arthroplasty, but also can be used as therapeutic agents. Recently, among APPs, fetuin A drew attention regarding its possible anti-inflammatory role in animal models but also as a therapeutic agent in the inflammatory joint disease in clinical trials. In contrast with other APPs such as C-reactive protein, fetuin A appears to be lower in the serum of patients with degenerative joint disease in comparison with the healthy ones, and also acts as an antagonist of the anti-proliferative potential of transforming growth factor-b(TGF-b) cytokines. Because of its lower serum levels in arthritis, an unregulated binding of TGF-b and bone morphogenetic proteins takes place leading to further arthritic lesions. The purpose of the present review is to assess the current evidence regarding the multipotent role of the alpha-2-HSglycoprotein or as also known Fetuin-a in animal models but also as a biomarker of the degenerative joint arthritis in clinical trials.
文摘AIM To investigate the association of psychiatric and psychosocial correlates with inflammatory bowel disease(IBD) activity in children and adolescents.METHODS A total of 85 pediatric IBD patients(in remission or active state of the disease) and their parents completed a series of questionnaires and semi-structured interviews measuring life events,depression,anxiety,family dysfunction,and parent mental health.Differences between the remission and the IBD active group and the association of any significant variable with the disease activity state were examined.RESULTS Parents of children being in active state of the disease reported more life events(P = 0.005) and stressful life events(P = 0.048) during the past year and more mental health symptoms(P < 0.001),while the childrenthemselves reported higher levels of anxiety symptoms(P = 0.017) compared to the remission group.In the logistic regression multivariate analysis,the only predictor which had a significant positive effect on the probability of the patients being in active state was parent mental health symptoms(OR = 4.8;95%CI:1.2-25.8).CONCLUSION Life events,child anxiety and parent mental health symptoms may be important correlates of pediatric IBD activity and targets of thorough assessment and treatment.
文摘Alcohol use disorder(AUD)represents a major public health issue which affects millions of people globally and consist a chronic relapsing condition associated with substantial morbidity and mortality.The gut microbiome plays a crucial role in maintaining overall health and has emerged as a significant contributor to the pathophysiology of various psychiatric disorders.Recent evidence suggests that the gut microbiome is intimately linked to the development and progression of AUD,with alcohol consumption directly impacting its composition and function.This review article aims to explore the intricate relationship between the gut microbiome and AUD,focusing on the implications for mental health outcomes and potential therapeutic strategies.We discuss the bidirectional communication between the gut microbiome and the brain,highlighting the role of microbiotaderived metabolites in neuroinflammation,neurotransmission,and mood regulation.Furthermore,we examine the influence of AUD-related factors,such as alcohol-induced gut dysbiosis and increased intestinal permeability,on mental health outcomes.Finally,we explore emerging therapeutic avenues targeting the gut microbiome in the management of AUD,including prebiotics,probiotics,and fecal microbiota transplantation.Understanding the complex interplay between the gut microbiome and AUD holds promise for developing novel interventions that could improve mental health outcomes in individuals with AUD.
文摘Advances in intraocular lens(IOL)design have rendered cataract surgery a refractive procedure.Newer IOL types include bifocal,trifocal and extended depth of focus(EDOF)IOLs.Their basic difference nestles in the number of focal points that each lens provides,which in turn leads to different visual outcomes.Familiarity of surgeons with the various characteristics of each lens is of utmost importance for accurate IOL selection to match each patient’s needs.In this review,we aim to compare the clinical outcomes after implantation of multifocal and EDOF IOLs in terms of distance,intermediate and near vision,contrast sensitivity,and reading performance.Finally,we discuss the defocus curve and the optical and photic phenomena associated with each type of IOL.
文摘Complicated acute appendicitis(CAA)is a serious condition and carries significant morbidity in children.A strict diagnosis is challenging,as there are many lesions that mimic CAA.The management of CAA is still controversial.There are two options for treatment:Immediate operative management and nonoperative management with antibiotics and/or drainage of any abscess or phlegmon.Each method of treatment has advantages and disadvantages.Operative management may be difficult due to the presence of inflamed tissues and may lead to detrimental events.In many cases,non-operative management with or without drainage and interval appendectomy is advised.The reasons for this approach include new medications and policies for the use of antibiotic therapy.Furthermore,advances in radiological interventions may overcome difficulties such as diagnosing and managing the complications of CAA without any surgeries.However,questions have been raised about the risk of recurrence,prolonged use of antibiotics,lengthened hospital stay and delay in returning to daily activities.Moreover,the need for interval appendectomy is currently under debate because of the low risk of recurrence.Due to the paucity of high-quality studies,more randomized controlled trials to determine the precise management strategy are needed.This review aims to study the current data on operative vs non-operative management for CAA in children and to extract any useful information from the literature.
文摘AIM: To evaluate the agreement of biomechanically corrected intraocular pressure(b-IOP) and central corneal thickness(CCT) measurements obtained with the updated Corvis ST tonometer versus Goldmann applanation tonometry(GAT) and optical-based corneal pachymetry(OB-CCT) in controls, patients with ocular hypertension(OHT) and primary open angle glaucoma(POAG).Additionally, we examined the differences in corneal deformation parameters provided by the updated Corvis ST among the three groups.METHODS: For each participant, GAT IOP, OB-CCT and measurements with a Corvis ST with updated software were obtained.Bland-Altman analysis was used to assess the agreement between the two measurement methods.RESULTS: A consecutive series of 80 eyes from 80 participants(30 with POAG, 25 with OHT and 25 normal controls) were included in this prospective study.The mean GAT IOP of all eyes was 17.2±3.6 mm Hg, and the mean b-IOP was 15.9±3.7 mm Hg(Spearman’s rho=0.767, P<0.001).The 95% limits of agreement(Lo As) ranged from-3.1 mm Hg to 5.5 mm Hg for GAT IOP and b-IOP.b-IOP was not correlated with OB-CCT(Spearman’s rho=-0.13 P=0.917).Meanwhile there was a weak positive corelation between OB-CCT and GAT IOP–b-IOP difference(Spearman’s rho=0.378, P=0.001).The mean OB-CCT was 549.5±36.4 μm, and the Corvis-CCT was 556.1±41.5 μm(Spearman’s rho=0.900, P<0.001).No statistically significant difference in the new indices provided by the updated Corvis ST was detected among the three groups.Compared with control eyes, POAG eyes had a significantly reduced applanation time 2 after adjusting for OB-CCT and GAT IOP(P=0.048).CONCLUSION: Corvis b-IOP and CCT correlate well with GAT IOP and OB-CCT.b-IOP is not affected by CCT, which might be an advantage, especially in thick or thin corneas.Corvis ST yields shorter applanation time 2 measurements in patients with POAG, which might reflect altered corneal viscoelasticity.
文摘Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual,“hands-on”,rescuer-delivered chest compressions.The-theoretical-advantages include high-quality non-stop compressions,thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially“hazardous”victim,or from hazardous and/or difficult resuscitation conditions.Such circumstances involve cardiopulmonary resuscitation(CPR)in the Cardiac Catheterization Laboratory,especially directly under the fluoroscopy panel,where radiation is well known to cause detrimental effects to the rescuer,and CPR during/after land or air transportation of cardiac arrest victims.Lastly,CPR in a coronavirus disease 2019 patient/ward,where the danger of contamination and further serious illness of the health provider is very existent.The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these“hostile”and dangerous settings,while comparing them to manual compressions.
文摘Type 2 diabetes mellitus(T2DM)is a leading risk factor for cardiovascular complications around the globe and one of the most common medical conditions.Atrial fibrillation(AF)is the most common supraventricular arrhythmia,with a rapidly increasing prevalence.T2DM has been closely associated with the risk of AF development,identified as an independent risk factor.Regarding cardiovascular complications,both AF and T2DM have been linked with high mortality.The underlying pathophysiology has not been fully determined yet;however,it is multifactorial,including structural,electrical,and autonomic pathways.Novel therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors,as well as antiarrhythmic strategies,such as cardioversion and ablation.Of interest,glucose-lowering therapies may affect the prevalence of AF.This review presents the current evidence regarding the connection between the two entities,the pathophysiological pathways that link them,and the therapeutic options that exist.
文摘The global spread of the novel severe acute respiratory syndrome coronavirus 2 has had serious consequences in terms of patient morbidity and mortality and overburdened health care systems as well as the socioeconomic implications.In the absence of effective therapies and vaccinations during the viral outbreak,the major and most concise means to control viral spread is spread prevention.Although information concerning the impact of severe acute respiratory syndrome coronavirus 2 on pediatric surgical patients has greatly expanded,relevant comprehensive studies are scarce.However,pandemic related morbidity has increased,while under normal circumstances mortality could have been minimized.
文摘Pancreatic ductal adenocarcinoma(PDAC)is nowadays the fourth leading cause of cancer-related death worldwide,but according to recent estimations it will become the second leading cause of cancer-related deaths in the USA up to 2030,following lung cancer.The implementation of neoadjuvant chemotherapy during recent years led to an increase of overall survival at 35 months in PDAC after R0 resection[1].However,pancreatic cancer has a particularity that makes it a real challenge for clinicians:only 20%of patients are diagnosed early enough to have a resectable pancreatic cancer,whereas 40%of patients present with locally advanced or non-resectable disease,while the rest present with distant metastases[2].Systemic chemotherapy plays the main role in metastatic PDAC treatment:polychemotherapy regimens such as FOLFIRINOX(folinic acid,5-fluorouracil,irinotecan and oxaliplatin)or combination of gemcitabine/nab-paclitaxel seemed to improve median overall survival from 6.8 to 11.1 months and 6.7 to 8.5 months,respectively[3].
文摘Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk of transformation to lymphoma.Case presentation:A case report is described and review of the literature from January 1975 to January 2019 was performed.A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions.Incisional biopsy revealed BRLH.Oral doxycycline was initiated(100 mg two times a day)for a total of 2 months.Both lesions decreased in size significantly at the patient’s two-month follow up visit.The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years.The lesion in the left eye has remained stable in size after cessation of the oral doxycycline.A total of 235 cases of conjunctival BRLH were identified in our literature search.The mean age at diagnosis was 35.2 years(range,5 to 91 years).BRLH lesions were unilateral in 75%of patients and bilateral in 25%of them.Seven patients(2.9%)had a concurrent Epstein-Barr virus(EBV)infection at the time of lesion appearance.The most common treatments were surgical excision(155/235 or 65.9%)and corticosteroids(30/235 or 12.7%),while 14%(33/235)of the patients were observed and 4.6%(11/235)received external beam radiotherapy alone.Recurrence occurred in ten patients(10/235 or 4.2%),of whom five had undergone surgical excision alone,two excision followed by external beam radiotherapy,one excision and oral corticosteroids,one radiotherapy alone and one had been treated with topical corticosteroids.Overall,only 2 of the 235 reported cases(0.8%)developed malignancy,one localized to the conjunctiva and one systemic.Conclusions:Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa.Extensive literature review shows that most cases are treated with surgery,steroids or observation.Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions.BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.
基金Thank you to Tzeni Troupi and Kimon Sfingos for performing the spirometry tests.
文摘Importance Vitamin A(or retinol)has considerable antioxidative and anti-inflammatory attributes and it may have protective effects on the respiratory health of patients with cystic fibrosis(CF).This issue,however,remains controversial.Objective The purpose of the present study was to investigate the relationship between serum retinol levels(SRL)and force expiratory volume in 1 second(FEV1)in patients with CF.Methods All patients with pancreatic insufficiency attending the CF Department of“Agia Sofia”Children’s Hospital in Athens,Greece,aged 6 to 19 years during the 2012–2016 period,who could perform spirometry effectively,were included in the study.The impact of SRL on FEV1 was examined longitudinally and analyzed with generalized estimating equations.Results The study included 231 patients and 851 SRL measurements were performed.In 25(3.2%)cases the SRL were below the 5th percentile of reference distribution;none was above the 95th percentile.The analysis showed that SRL was positively correlated with the FEV1(P<0.001).Interpretation In this sample of children and adolescents with CF,vitamin A deficiency was rare.Our results suggest a positive relationship between SRL and FEV1.
文摘The classical cerebrospinal fluid biomarkers of Alzheimer's Disease (namely total tau, phospho-tau and amyloid beta peptide) have received much attention, since they can detect the biochemical fingerprint of Alzheimer's disease and serve as a diagnostic aid for correct diagnosis of cognitive disorders during life. In this case series, we present 6 examples of patients with cognitive impairment of various types and severities and how biomarker data were helpful in every day diagnostic approach, combined with clinical, neuropsychological and imaging data and based on the most recent guidelines and recommendations.
文摘Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,cardiac transplant patients exhibit worse cardiovascular prognosis,high mortality,and more admissions to the intensive care unit.In general,COVID-19 seems to deteriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure,especially in the presence of cardiovascular comorbidities such as diabetes mellitus,kidney dysfunction,and older age.COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury.Indeed,myocardial injury comprises a large category of detrimental effects for the myocardium,such as myocardial infarction type 1 or type 2,Takotsubo cardiomyopathy,microvascular dysfunction and myocarditis,which are not easily distinguished by HF.The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2,cytokine storm,hypercoagulation,inflammation,and endothelial dysfunction.The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.
文摘Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), is the most common cause of inherited cerebral small vessel disease, inherited stroke and inherited vascular dementia. It is not infrequent for CADASIL to be mistaken and mistreated for multiple sclerosis (MS). A much less frequent but existing scenario is the co-occurrence of CADASIL and MS (or MS-like inflammatory condition). Such patients may present with spinal cord lesions, brain or spinal cord enhancing lesions, positive oligoclonal bands and high IgG index in the cerebrospinal fluid and good response to corticosteroids or immunomodulating treatments. CADASIL through various mechanisms may trigger or modulate autoimmune reactions, and either be complicated by an inflammatory component or cause an MS-like disorder.
文摘The core(established)cerebrospinal fluid biomarkers of Alzheimer's disease(AD),namely amyloid-beta peptide,total tau protein and phospho-tau protein,have become a part of the diagnostic workup of patients with cognitive disorders in many specialized centers,especially for ambiguous cases.Combined,these biomarkers can identify the presence or absence of an AD biochemical process with sensitivities and specificities approaching or exceeding 90%in both dementia and pre-dementia stages of AD.Thus,they have been incorporated in various sets of research or clinical diagnostic criteria and recommendations.Results that are atypical,incompatible with AD,or inconclusive may occur,necessitating the use of other cerebrospinal fluid or imaging biomarkers.
