Radiological findings in non-surgical recurrent hepatocellular carcinoma:From locoregional treatments to immunotherapy

Since hepatocellular carcinoma(HCC)represents an important cause of mortality and morbidity all over the world.Currently,it is fundamental not only to achieve a curative treatment but also to manage in the best way any possible recurrence.Even if the latest update of the Barcelona Clinic Liver Cancer guidelines for HCC treatment has introduced new locoregional techniques and confirmed others as well-established clinical practices,there is still no consensus about the treatment of recurrent HCC(RHCC).Locoregional treatments and medical therapy represent two of the most widely accepted approaches for disease control,especially in the advanced stage of liver disease.Different medical treatments are now approved,and others are under investigation.On this basis,radiology plays a central role in the diagnosis of RHCC and the assessment of response to locoregional treatments and medical therapy for RHCC.This review summarized the actual clinical practice by underlining the importance of the radiological approach both in the diagnosis and treatment of RHCC.

Treatment outcomes and cognitive function following electroconvulsive therapy in patients with severe depression

BACKGROUND Traditional treatments for major depressive disorder(MDD),including medication and therapy,often fail and have undesirable side effects.Electroconvulsive therapy(ECT)uses electrical currents to induce brief seizures in the brain,resulting in rapid and potent antidepressant effects.However,owing to misconceptions and controversies,ECT is not as widely used as it could and often faces stigmatization.AIM To evaluate the efficacy and safety of ECT compared to those of medication and/or therapy in patients with severe MDD.METHODS This prospective cohort study included 220 individuals with severe MDD who were divided into the ECT and non-ECT groups.The patients in the ECT group underwent bilateral ECT three times a wk until they either achieved remission or reached a maximum of 12 sessions.The non-ECT group received medication and/or therapy according to clinical guidelines for MDD.The primary outcome was the variation in the hamilton depression rating scale(HDRS)score from treatment/ECT initiation to week 12.In addition,patients’quality of life,cognitive abilities,and biomarkers were measured throughout the study.RESULTS Although both groups showed significant improvements in their HDRS scores over time,the improvement was more pronounced in the ECT group than in the non-ECT group.Additionally,the ECT group exhibited a more substantial improvement in the quality of life and cognitive function than those of the non-ECT group.Compared with the non-ECT group,the ECT group exhibited evidently lower variations in the brain-derived neurotrophic factor(BDNF)and cytokine interleukin-6(IL-6)levels.The side effects were generally mild and comparable between the two groups.ECT is safer and more potent than medication and/or therapy in mitigating depressive symptoms,enhancing wellbeing,and bolstering cognitive capabilities in individuals with severe MDD.ECT may also affect the levels of BDNF and IL-6,which are indicators of neuroplasticity and inflammation,respectively.CONCLUSION ECT has emerged as a potentially advantageous therapeutic approach for patients with MDD who are unresponsive to alternative treatments.

Medical management of urolithiasis: Great efforts and limited progress

Objective:To provide a comprehensive review on the existing literature on medical management of urolithiasis.Methods:A thorough literature review was performed using Medline,PubMed/PMC,Embase,and the Cochrane Database of Systematic Reviews up to December 2022 to identify publications on the medical management of urolithiasis.Studies that assessed dietary and pharmacologic management of urolithiasis were reviewed;studies on medical expulsive therapy were not included in this review.Results:Medical management of urolithiasis ranges from the prophylactic management of kidney stone disease to dissolution therapies.While most treatment concepts have been long established,large randomized controlled trials are scarce.Dietary modification and increased fluid intake remain cornerstones in the conservative management of urolithiasis.A major limitation for medical management of urolithiasis is poor patient compliance.Conclusion:Medical management of urolithiasis is more important in patients with recurrent urolithiasis and patients with metabolic abnormalities putting them at higher risk of developing stones.Although medical management can be effective in limiting stone recurrence,medical interventions often fail due to poor compliance.

PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Medical therapy for nephrolithiasis:State of the art

The prevalence of nephrolithiasis is increasing worldwide.Understanding and implementing medical therapies for kidney stone prevention are critical to prevent recurrences and decrease the economic burden of this condition.Dietary and pharmacologic therapies require understanding on the part of the patient and the prescribing practitioner in order to promote compliance.Insights into occupational exposures and antibiotic use may help uncover individual risk factors.Follow-up is essential to assess response to treatment and to modify treatment plans to maximize therapeutic benefit.

What constitutes failure of medical therapy in the changing landscape of Crohn's disease?

The management of Crohn's disease has evolved rapidly in the era of immunomodulators and biologicals.Despite this,a significant proportion of patients with Crohn's disease ultimately require surgical management.One of the indications for operative management includes failure of medical therapy.We report two cases of patients with complicated Crohn's disease who have exhausted medical therapy and failed medical management.In both cases,the patients developed large complex intra-abdominal phlegmons and intractable symptoms of intermittent pain,partial obstruction and/or infectious complications requiring operative intervention.Crohn's disease can present with a wide spectrum of disease.Considering the complexity of management in Crohn's disease,it is important for both physicians and surgeons to be aware of what constitutes failure of medical therapy and when it may be important to consider surgical involvement.

Comparison of the anti-apoptotic effects of 15-and 35-minute suspended moxibustion after focal cerebral ischemia/reperfusion injury

Heat-sensitive suspended moxibustion has a neuroprotective effect against focal cerebral ischemia/reperfusion injury, but the underly- ing mechanisms remain unclear. The duration of heat-sensitive suspended moxibustion （usually from 30 minutes to 1 hour） is longer than traditional suspended moxibustion （usually 15 minutes）. However, the effects of 15- and 35-minute suspended moxibustion in rats with cerebra/ischemia/reperfusion injury are poorly understood. In this study, we performed 15- or 35-minute suspended moxibustion at acupoint Dazhui （GV14） in an adult rat model of focal cerebral ischemia/reperfusion injury. Infarct volume was evaluated with the 2,3,5-triphenyltetrazolium chloride assay. Histopathological changes and neuronal apoptosis at the injury site were assessed by hematoxy- lin-eosin staining and terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Caspase-9 and caspase-3 expression at the in- jury site was detected using immunofluorescent staining. Bax and Bcl-2 expression at the injury site was assessed using western blot assay. In the 35-minute moxibustion group, infarct volume was decreased, neuronal apoptosis was reduced, caspase-9, caspase-3 and Bax expres- sion was lower, and Bcl-2 expression was increased, compared with the 15-minute moxibustion group. Our findings show that 35-minute moxibustion has a greater anti-apoptotic effect than 15-minute moxibustion after focal cerebral ischemia/reperfusion injury.

Role of endoscopy in predicting the disease course in inflammatory bowel disease

Endoscopy provides a direct evaluation of mucosal lesions in inflammatory bowel disease(IBD),permitting the description of elementary lesions,their surface extent and severity.The severity of mucosal lesions directly reflects disease activity and may help to identify an aggressive behavior of the disease.Several studies have recently pointed out the potential role of endoscopy in the prediction of IBD outcome.Indeed,severe endoscopic lesions in Crohn's disease(CD) patients,defined by deep and extensive ulcerations on at least one part of the colon,are associated with an increased risk of penetrating complication and surgery.Severe endoscopic lesions during severe attacks of ulcerative colitis(UC) are associated with an increased risk of colectomy in the short and long term.Severity of postoperative recurrence in CD may help to predict the risk of clinical relapse and need for further surgery.Achievement of mucosal healing,which can be obtained by administration of several types of drugs,is associated with a better outcome,less surgery and hospitalization.This review focuses on the assessment of endoscopic severity in CD and UC and on the impact of endoscopic severity on disease outcome.More specifically,we discuss how endoscopy can be used at different stages of IBD to predict the disease course and/or to adapt treatment strategies.

Common approach to managing lower urinary tract symptoms and erectile dysfunction

The present paper serves as a review of the associations between lower urinary tract symptoms （LUTS） and erectile dysfunction （ED）, with a focus on common and combined pathways for treatment. LUTS and ED are common conditions seen in general urologic practice. Research has started to establish epidemiologic and pathophysiologic links between the two conditions and a strong association confirmed across multiple studies. Men seeking care for one condition should always be interviewed for complaints of the other condition. Proposed common pathways include α-1 adrenergic receptor imbalance, Rho-kinase overactivity, endothelial cell dysfunction and atherosclerosis-induced ischemia. Medical therapy has replaced surgery as the first-line treatment for LUTS in most patients, with the incorporation of α-adrenergic receptor antagonists （α-ARAs） and 5-α-reductase inhibitors （5-ARIs） into everyday practice. Treatment with α-ARAs contributes to some improvement in ED, whereas use of 5-ARIs results in worsened sexual function in some patients. Phosphodiesterase-5 （PDE-5） inhibitors have revolutionized the treatment of ED with a simple oral regimen, and new insights demonstrate a benefit of combined use of PDE-5 inhibitors and α-ARAs. The mechanisms of action of these medications support these observed benefits, and they are being studied in the basic science and clinical settings. In addition, novel mechanisms for therapy have been proposed based on clinical and research observations. The minimally invasive and surgical treatments for LUTS are known to have adverse effects on ejaculatory function, while their effects on erectile function are still debated. Much remains to be investigated, but it is clear that the associations between LUTS and ED lay the foundation for future therapies and possible preventative strategies.

Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China:A large,multicenter,retrospective cohort study using a propensity score matching analysis

Background:Hepatitis B virus-related acute-on-chronic liver failure(HBV-ACLF)has a high short-term mortality.However,the treatment progression for HBV-ACLF in China in the past decade has not been well characterized.The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade.Methods:This study retrospectively compared short-term(28/56 days)survival rates of two different nationwide cohorts(cohort I:2008-2011 and cohort II:2012-2015).Eligible HBV-ACLF patients were enrolled retrospectively.Patients in the cohorts I and II were assigned either to the standard medical therapy(SMT)group(cohort I-SMT,cohort II-SMT)or artificial liver support system(ALSS)group(cohort IALSS,cohort II-ALSS).Propensity score matching analysis was conducted to eliminate baseline differences,and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival.Results:Short-term(28/56 days)survival rates were significantly higher in the ALSS group than those in the SMT group(P<0.05)and were higher in the cohort II than those in the cohort I(P<0.001).After propensity score matching,short-term(28/56 days)survival rates were higher in the cohort II than those in the cohort I for both SMT(60.7%vs.53.0%,50.0%vs.39.8%,P<0.05)and ALSS(66.1%vs.56.5%,53.0%vs.44.4%,P<0.05)treatments.The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments(P=0.046).Multivariate logistic regression analysis revealed that ALSS(OR=0.962,95%CI:0.951-0.973,P=0.038),nucleos(t)ide analogs(OR=0.927,95%CI:0.871-0.983,P=0.046),old age(OR=1.028,95%CI:1.015-1.041,P<0.001),total bilirubin(OR=1.002,95%CI:1.001-1.003,P=0.004),INR(OR=1.569,95%CI:1.044-2.358,P<0.001),COSSH-ACLF grade(OR=2.683,95%CI:1.792-4.017,P<0.001),and albumin(OR=0.952,95%CI:0.924-0.982,P=0.002)were independent factors for 28-day mortality.Conclusions:The treatment for patients with HBV-ACLF has improved in the past decade.

Gestational diabetes from A to Z

Gestational diabetes mellitus(GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus(T2 DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2 DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2 DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent welldesigned clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.

Prevention of Coronary Heart Disease: A Translational Clinical Challenge

Introduction: Atherosclerotic cardiovascular disease is a dysmetabolic medical condition resulting in the #1 cause of morbidity and mortality in the United States. Coronary Artery Calcium (CAC) CT non-invasively identifies atherosclerosis in asymptomatic individuals. This translational study tested the hypothesis that clinically overtcardiovascular disease can be prevented in asymptomatic individuals in a medical clinic. Methods: Two hundred and six asymptomatic adults requested a CAC scan to identify subclinical heart disease. Individuals with a positive CAC score > 1 (n = 125) were prescribed targeted medical therapy to reverse their atherosclerosis. The goal was to achieve an LDL Cholesterol (LDL-C) ≤ 60 mg/dl. One hundred and ten individuals reached this goal (67 male, 43 female) receiving 10 mg/d of rosuvastatin and 10 mg/d of ezetimibe plus a low cholesterol diet. Other fifteen individuals with positive CAC scores did not achieve this LDL-C goal. Results: In the group following medical therapy and achieving an LDL-C ≤ 60 mg/dl, no cardiovascular events were observed during a maximum observation period of 5 years (mean observation time = 3.6 years). Based on previously published CVD outcome data in individuals with similar CAC scores, 12.6 cardiovascular events were expected. Two of fifteen individuals with positive CAC scores not following medical therapy had a cardiovascular event. None of the 81 individuals with a zero score had a cardiovascular event during follow-up. No adverse effects of therapy occurred. Conclusion: In a medical clinic, adult population with positive CAC scores and an LDL-C ≤ 60 mg/dl, targeted medical therapy prevented overt cardiovascular disease. These results should encourage other physicians to aggressively treat atherosclerotic cardiovascular disease in their clinic populations.

Long-term outcomes in patients initially responsive to selective laser trabeculoplasty

AIMTo determine the long-term effects of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and the number of medications used up to 5y following treatment in glaucoma patients receiving maximally tolerated medical therapy (MTMT).METHODSThe Wills Eye Hospital Glaucoma Research Center retrospectively reviewed the charts of glaucoma patients who underwent SLT after receiving MTMT. Eyes that did not achieve their target pressure within 3mo following SLT were excluded from the study. Changes in mean IOP and number of glaucoma medications used were analyzed at 1, 3, and 5y following SLT.RESULTSSeventy-five eyes of 67 patients were included in the study. Fifteen eyes that received SLT failed to achieve their target pressure within 3mo and were excluded from the study. The average follow-up time was 37.4mo (&#x000b1;14.4). Mean IOP was significantly reduced 1y after treatment (P=0.005). It was also reduced 3, 5y after treatment without reaching statistical significance (P=0.20 and P=0.072, respectively). There was a significant decrease in mean number of medications used 1, 3, 5y after treatment (P&#x0003c;0.001, P&#x0003c;0.001, and P=0.039, respectively). In the span of 5y, 2 eyes (2.7%) underwent repeat SLT, 7 eyes (9.3%) underwent glaucoma surgery and an additional 3 eyes (4.0%) underwent both.CONCLUSIONSLT significantly reduced the number of glaucoma medications used 5y following treatment in glaucoma patients receiving MTMT. SLT may delay operating-room surgery.

Preventing Heart Disease via Coronary Artery Calcium Scoring to Make a Definitive Diagnosis of Atherosclerosis

Purpose: Cardiovascular disease is the number one cause of death in the Western world. The purpose of this manuscript is to compare the benefits and deficiencies of coronary artery calcium scanning versus computer generated risk equations in identifying atherosclerotic cardiovascular disease. These two approaches provide significantly different cardiovascular risk assessments and often lead to therapeutic differences in recommendations from the physician to the patient. Methods: Pertinent medical literature is reviewed concerning both risk assessment approaches (i.e., coronary artery scanning and computer generated risk equations). The strengths and weaknesses of both approaches are discussed, and recommendations are provided based upon available data. Results: Cardiovascular risk equations are simple and readily obtained at no charge by physicians. However, their drawbacks are several, including non-applicability to specific populations, disagreements among different cardiovascular society risk equations, wide ranges of risk outputs (e.g., intermediate 10-year risk is between 5% and 20%), inability to definitively identify coronary artery plaques, and lack of definitive anatomical coronary disease. Alternatively, coronary artery calcium scanning costs approximately $100/scan (if not covered by insurance), requires time and effort by the patient, and exposes the patient to a minimal amount of radiation. However, coronary calcium scanning identifies specific atherosclerotic coronary disease and provides additional information about the anatomical location (i.e., coronary artery) of the atherosclerotic plaque. Conclusion: Based on the published literature, coronary artery calcium scanning is the preferred approach for identifying atherosclerotic cardiovascular disease. Although there are minor drawbacks, overall it provides superior clinical information compared with computer generated risk equations.

A Review for Existing Complementary and Alternative Medical Therapies for Autism Spectrum Disorder

Autism Spectrum Disorder(ASD)has always been a frustrating disability for families and no official effective medical interventions has been found to cure this disorder yet.With more attention from the general public both nationally and internationally,more and more families and therapists showed preference to implement complementary and alternative medical(CAM)therapies.This review aims to provide more information about potential CAM that has been applied and their effectiveness.

Bladder calculi concomitant with benign prostatic enlargement:is prostate surgery mandatory in patients who have never received medical therapy?

The historical dogma that bladder calculi comprise the main indication for prostatic surgery has recently been questioned.In this study,we aimed to predict which patients should undergo simultaneous prostate and bladder calculi surgery or only bladder calculi removal by evaluating preoperative risk factors.One hundred and seventeen men with bladder stones and concomitant benign prostate enlargement(BPE)who had not received medical treatment before were included in the study.In the first step,only the bladder calculi of patients were removed and medical treatment was given for BPE.The patients who benefited from medical treatment during the follow-up were defined as Group 1 and the patients who required prostate surgery for any indication comprised Group 2.Risk factors for prostate surgery requirements were determined by comparing preoperative characteristics between the two groups with a cox regression model.In the follow-up of 117 patients with bladder stones removed and medical treatment initiated,49(41.9%)patients had prostate surgery indications.The indication for 33(67.3%)of 49 patients was medical treatment failure.The presence of intravesical prostatic protrusion(IPP;hazard ratio:2.071,95%confidence interval[Cl]:1.05-4.05,P=0.034),and high postvoiding residual urine volume(hazard ratio:1.013,95%Cl:1.007-1.019,P<0.001)were found to be preoperative risk factors for needing future prostate surgery.In patients who have not received medical treatment for BPE before,bladder calculi developing secondary to BPE do not always constitute an indication for prostate surgery.

Retrospective Analysis of Thrombolysis Therapy for 64 Cases of Acute Myocardial Infarction with Elevated ST Segment

Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalization by thrombolysis were assigned to two groups by retrospective analysis,36 patients in the treated group and 28 in the control group.Both were treated by intravenous administering of urokinase for thrombolysis,and to the treated group,intravenous dripping of Xueshuantong Injection(血栓通注射液,XST) ...

Medical expulsion therapy for urinary calculi

C urrently, the predominant therapy for urinary calculi is minimally invasive treatment, which could reduce injury to patients while enhancing the success rate, compared to traditional open surgery. Minimally invasive treatments in urinary system include extracorporeal shock wave lithotripsy （ESWL）, percutaneous nephro- stolithotomy （PCNL）, ureteroscopic lithotripsy （URSL）, laparoscopy, and so on. Despite the relative small injury,

Medical treatments of endometriosis: a review

Endometriosis is a chronic gynecological disorder that affects approximately 10%of women of reproductive age.Most medical treatments used today for endometriosis pain are hormonal therapies,which are not an option for those trying to conceive and are not tolerated by a subset of patients due to side effects.In this article,we offer a comprehensive review of current and investigational medical therapeutic options used to treat endometriosis pain,as well as a symptom-based systematic approach for patients with painful endometriosis.We have also included recommendations for research to enhance the evolution of novel therapeutic options.A thorough literature search was carried out,and the data were synthesized using a synthesis matrix that classifies and categorizes various arguments.