Application Effect of Health Management in Community Diabetic Population

Objective: This study aims to improve the health level of patients with diabetes in the community through health management measures under the concept of health management. Methods: Community residents were selected to detect, collate and analyze the social demographic information, body mass index, fasting blood glucose and blood lipid level of diabetic patients before and after health management. Results: The study showed that after the implementation of health management education in the community, the detection rate of diabetes patients increased, but the population was no longer mainly elderly patients, but mainly people under 60 years old. The levels of body mass index, fasting blood glucose, triglyceride (TG), total cholesterol (TC) and low-density lipoprotein (LDL) were significantly decreased (all P Conclusion: Through the investigation of patients before and after health management in residential communities, this study shows that the correct implementation of health management can effectively improve the physiological indicators of diabetes patients, improve the level of health quality, and provide a reference for the prevention and treatment of diabetes patients in communities.

Artificial Intelligence and Computer Vision during Surgery: Discussing Laparoscopic Images with ChatGPT4—Preliminary Results

Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.

Upper extremity vascular injuries:Etiology,management and outcome

BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.

Should hot biopsy forceps be abandoned for polypectomy of diminutive colorectal polyps?

Standardized approach to polypectomy of diminutive colorectal polyps(DCPs) is lacking since cold biopsy forceps have been associated with high levels of recurrence, hot biopsy forceps are considered inadequate and risky and cold snaring is currently under investigation for its efficacy and safety. This has led to confusion and a gap in clinical practice. This article discusses the usefulness and contemporary practical applicability of hot biopsy forceps and provides wellintentioned criticism of the new European guidelines for the treatment of DCPs. Diminutive colorectal polyps are a source of frustration for the endoscopist since their small size is accompanied by a considerable risk of premalignant neoplasia and a small but nonnegligible risk of advanced neoplasia and even cancer. Since the proportion of diminutive colorectal polyps is substantial and exceeds that of larger polyps, their effective removal poses a considerable workload and a therapeutic challenge. During the last decade, the introduction of cold snaring to routine endoscopy practice has attempted to overcome the use of prior techniques, such as hot biopsy forceps. It is important to recognize that with the exception of endoscopic methods that are obviously unsafe and inadequate to serve their purpose, all other interventional endoscopic methods are operator-dependent in the sense that specific expertise and training are obligatory for the success of any therapeutic intervention. Since relevant publications on hot biopsy forceps are still in favor of its careful use, as it has not yet demonstrated inferiority compared with newer techniques, it would be prudent for any medical practitioner to evaluate the available tools and judge any new proposed technique based on the evidence before it is adopted.

Tranexamic acid for the management of uterine fibroid tumors:A systematic review of the current evidence

AIM: To conduct a detailed systematic review of the current evidence on the administration and efficacy of tranexamic acid in patients with menorrhagia due to uterine fibroids. METHODS: We conducted an electronic search on the following databases Pub Med and Medline(1950-2013);(1980-2013); Cochrane library(1993-2013). RESULTS: A total of 36 articles were retrieved after the initial electronic search. Careful assessment of the retrieved studies led to the final selection of 5 articles for inclusion in the review. CONCLUSION: Tranexamic acid may reduce blood loss perioperatively in myomectomies. It may reduce the menorrhagia in patients with fibroids, however a stratification of fibroids by size and location is required to define the responses. It is safe in general, with mild adverse effects observed in some cases. More studies with a double-blind randomized design and larger numbers of participants are necessary to reach more precise and safe conclusions.

Role of bariatric surgery in the pelvic floor disorders

Pelvic floor disorders are very frequent among women. Weight loss can help them to achieve urinary and faecal continence again. In this narrative review, the possible mechanisms of pelvic floor disorders in obese women, their symptoms and the role of bariatric surgery in changing their quality of life are presented. We retrieved the included results of our study after performing a systematic, electronic search in PubMed(December 17, 2012) and Scopus(December 17, 2012). The main mechanism causing the development of pelvic floor disorders is chronically increased abdominal pressure as it overts structural damage or neurologic dysfunction predisposing to prolapse and incontinence. The symptoms include a sensation of vaginal fullness or pressure, uterine descent, sacral back pain with standing, vaginal spotting from ulceration of the protruding cervix or vagina, coital difficulty, lower abdominal discomfort, and voiding and defecatory difficulties. Evidence indicates that massive weight loss(45 to 50 kg) improves incontinence in morbidly obese women after bariatic surgery. Faecal incontinence is also improved after bariatric surgery. This review highlights the role of bariatric surgery in weight reduction of obese women that could act as a treatment for the pelvic floor disorders faced by those women offering improvement in incontinence as well as quality of life.

Update in combined musculoskeletal and vascular injuries of the extremities

Combined musculoskeletal and vascular injuries of the extremities are conditions in which a multidisciplinary approach is a sine qua non to ensure life initially and limb viability secondarily.Vascular injuries as part of musculoskeletal trauma are usually the result of the release of a high energy load in the wound site so that the prognosis is determined by the degree of soft-tissue damage,duration of limb ischemia,patient’s medical status and presence of associated injuries.The management of these injuries is challenging and requires a specific algorithm of action,because they are usually characterized by increased morbidity,amputation rate,infection,neurological and functional deficits,and they could be life threatening.Although vascular injuries are rare and occur either isolated or in the context of major combined musculoskeletal trauma,the high index of suspicion,imaging control,and timely referral of the patient to organized trauma centers ensure the best functional outcome of the extremity in such challenging cases.Even after a successful initial treatment of a combined trauma pattern,long-term follow-up is crucial to prevent and detect early possible complications.The purpose of this manuscript is to provide an update on diagnosis and treatment of combined musculoskeletal and vascular injuries of the extremities,from an orthopedic point of view.

Medico-legal risks associated to hand and wrist trauma

BACKGROUND Acute hand and wrist injuries are common and may lead to long-term disability if not managed adequately.Claims for negligence have been increasing in medical practice over the past few decades,with hand and wrist injuries and their treatment representing a significant percentage of orthopedic surgery lawsuits.There is no available literature regarding medical malpractice claims in hand and wrist injuries and surgery in Greece.AIM To identify claims related to hand and wrist trauma and surgery and to define the reasons of successful litigations.METHODS We performed a retrospective study of all legal claims of negligence for hand and upper extremity surgery that went to a trial,attributed to all surgical specialties,in Greece for a 20-year period.Data was further analyzed to identify claims related to hand and wrist trauma and surgery.RESULTS There were six malpractice claims related to hand and wrist trauma that ended in a trial.A missed diagnosis,which resulted in failure of initial management of the injury,was the main reason for a claim.Three of the six cases resulted in complete or partial loss of a finger.Two cases are still open,requiring an expert witness’s report,two cases were closed in favor of the defendant,and two cases were closed in favor of the plaintiff with a mean compensation of€2000(€1000-€3000).CONCLUSION Missed diagnosis was the main reason for a malpractice claim.Better understanding of factors leading to successful claims will help surgeons improve their practice to minimize legal implications and litigation.

Postpartum fatal cerebral vein thrombosis: A case report and review

Background: Cerebral vein thrombosis, is an emergent condition presenting with a variety of symptoms ranging from isolated headache to profound coma. Case Presentation: We present the case of a previously healthy young woman on the 18th postpartum day admitted into our hospital with a persistent headache for three days followed by seizures and coma. Magnetic Resonance Angiography revealed superior sagittal sinus and right transverse sinus thrombosis. Despite supportive measures and anticoagulation, the patient died because of uncontrolled increase in intracranial pressure. Conclusion: The possibility of cerebral vein thrombosis should be considered in all women with brain dysfunction during the puerperium.

药品监管科学研究之基因和细胞治疗产品Ⅰ:我国监管体系的问卷调研及结果分析

目的:梳理我国基因和细胞治疗领域监管体系存在的突出问题,探索加强该领域监管体系建设的可行措施。方法:在前期文献调研的基础上,提炼关键要素,开展问卷调查,并对调查结果进行分析。采用非概率抽样法,选择从事基因和细胞治疗产品监管、研发、注册、生产等工作专业人员作为调查对象,以微信方式发放电子问卷进行调查。结果:大多数调研对象认为,我国现行基因和细胞治疗产品监管体系还不能满足产业发展的需求,需要进一步的改进和完善。结论:本调研为进一步提出我国基因和细胞治疗产品监管体系的完善建议提供了数据支持。

Microglandular hyperplasia-like mucinous adenocarcinoma of the endometrium: A rare case report

BACKGROUND Microglandular hyperplasia(MGH)is a proliferation of endocervical glands,related to estrogen stimulation,mainly occurring in the reproductive age group.The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern(MGA),a distinction that may be particularly problematic in curettage specimen.CASE SUMMARY A 57-year-old,postmenopausal woman was admitted in our hospital for surgical treatment.She had been diagnosed with a uterine leiomyoma,after complaints of irregular vaginal bleeding.She underwent dilatation and curettage(D&C)and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy.D&C were compatible with MGA.Histologically,a proliferation of small glands,without intervening stroma,with mucin production,accumulation of neutrophils in the gland lumen and stroma,mild nuclear atypia and rare mitoses,were seen.In the hysterectomy specimen,the endometrium was thickened,but without apparent tumor formation.On microscopic examination,a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type,in the rest of the endometrium.CONCLUSION MGH-like proliferation with mild cytologic atypia,detected in the endometrial curettage specimen of a postmenopausal woman,should alert pathologists for MGA of the endometrium.VIM,p16,PAX-2,CD10 and CD34 may help in the differential diagnosis.

Diagnostic Yield of Non-Invasive Testing in Patients with Anomalous Aortic Origin of Coronary Arteries:A Multicentric Experience

Background:Anomalous aortic origin of a coronary artery(AAOCA)is a congenital heart disease with a 0.3%−0.5%prevalence.Diagnosis is challenging due to nonspecific clinical presentation.Risk stratification and treatment are currently based on expert consensus and single-center case series.Methods:Demographical and clinical data of AAOCA patients from 17 tertiary-care centers were analyzed.Diagnostic imaging studies(Bidimensional echocardiography,coronary computed tomography angiography[CCTA]were collected.Clinical correlations with anomalous coronary course and origin were evaluated.Results:Data from 239 patients(42%males,mean age 15 y)affected by AAOCA were collected;154 had AAOCA involving the right coronary artery(AAORCA),62 the left(AAOLCA),23 other anomalies.211(88%)presented with an inter-arterial course.Basal electrocardiogram(ECG)was abnormal in 37(16%).AAOCA was detected by transthoracic echocardiography and CCTA in 53%and 92%of patients,respectively.Half of the patients reported cardiac symptoms(119/239;50%),mostly during exercise in 121/178(68%).An ischemic response was demonstrated in 37/106(35%)and 16/31(52%)of patients undergoing ECG stress test and stress-rest single positron emission cardiac tomography.Compared with AAORCA,patients with AAOLCA presented more frequently with syncope(18%vs.5%,P=0.002),in particular when associated with inter-arterial course(22%vs.5%,P<0.001).Conclusion:Diagnosis of AAOCA is a clinical challenge due to nonspecific clinical presentations and low sensitivity of first-line cardiac screening exams.Syncope seems to be strictly correlated to AAOLCA with inter-arterial course.

High PSMA expression is associated with immunosuppressive tumor microenvironment in clear cellrenal cell carcinoma

Dear Editor,Clear cell renal cell carcinoma(ccRCC)is a highly vascular tumor.Among surrogate markers that may reflect the neovasculature burden of ccRCC,prostate specific membrane antigen(PSMA)has emerged as a promising one,by virtue of its ability to be measured either immunohistochemically and transcriptionally or on positron emission tomography(PET)imaging[1,2].While the relationship between PSMA and neoangiogenesis in ccRCC is well established,the potential association between PSMA and the immune landscape of ccRCC is much less understood.

自体嵌合抗原受体T细胞(CAR-T)治疗产品药学变更实践与思考

近年来我国在嵌合抗原受体T细胞(CAR-T cell)治疗领域的研究非常活跃。由于该领域技术迭代快,生产工艺复杂,药学研究和变更方面的经验相对有限,CAR-T产品药学变更的评估、研究以及申报、审评对企业和监管机构提出了多方面的挑战。本课题组聚焦于自体CAR-T细胞治疗产品药学变更案例及其共性问题与挑战,进行了行业调查、法规与案例收集和研讨以及变更管理工具评估,并提出了多项建议,期望为企业和监管机构管理CAR-T药学变更提供参考。相关法规收集与分析结果显示,我国和美国在法规方面均走在前沿,总体原则均为基于科学和风险;在细节和实践上,监管机构均处于持续研究、探讨和完善的阶段。行业调研结果显示,企业药学变更主要目的之一是降低成本以提高产品可及性,主要挑战包括企业和监管机构对变更理解的差异、沟通机制以及审评审批时长。收集的药学变更案例包括多种变更情形,其中针对扩大生产产能,建议基于适当产品与工艺知识经验、风险管控和无菌验证,可使用同步验证,适当时使用模拟验证辅助。就上市后变更管理工具,建议试行ICH Q12批准后变更管理方案(PACMP)帮助管理自体CAR-T细胞治疗产品上市后药学变更。

Anti-BCMA CAR T-cell therapy CT103A in relapsed or refractory AQP4-IgG seropositive neuromyelitis optica spectrum disorders:phase 1 trial interim results

Chimeric antigen receptor(CAR)T-cell therapy that targets B-cell maturation antigen(BCMA)have great potentials in autoimmune diseases and could be novel therapeutics for relapsed/refractory neuromyelitis optica spectrum disorder(NMOSD).To evaluate the safety and efficacy of the CT103A,a self-developed BCMA-targeting CAR construct against BCMA,in patients with AQP4-IgG seropositive NMOSD,an ongoing,investigator-initiated,open-label,single-arm,phase 1 clinical trial is conducted at our center.In total,12 patients were administered with a CAR-BCMA infusion.Ten of the 12 patients dosed were women(83.3%),with a median age of 49.5 years(range,30-67).were The most common events of grade 3 or higher were hematologic toxic effects.Seven patients(58%)developed infections,but no grade 4 infections occurred.Cytokine release syndrome was reported in all patients with only events of grade 1 or 2 observed.During the follow-up of a median 5.5 months,11 patients had no relapse;all patients generally reported improvement in disabilities and quality-of-life outcomes;11 patients’AQP-4 antibodies in serum showed a downward trend by the cutoff date.CAR T-cell expansion was associated with responses,and persisted more than 6 months post-infusion in 17%of the patients.In summary,CAR T-cell therapy shows a manageable safety profile and therapeutic potentials for patients with relapsed/refractory AQP4-IgG seropositive NMOSD.Another expansion phase is currently underway to determine the safety and efficacy of CAR T-BCMA infusion in patients with other neuro-inflammatory diseases.

T cells expressing CD5/CD7 bispecific chimeric antigen receptors with fully human heavy-chain-only domains mitigate tumor antigen escape

Bispecific chimeric antigen receptor T-cell(CAR-T)therapies have shown promising results in clinical trials for advanced B-cell malignancies.However,it is challenging to broaden the success of bispecific CAR-T therapies to treat refractory/relapse(r/r)T-cell leukemia/lymphoma because targeting multiple T-cell-expressing antigens leads to exacerbated CAR-T cell fratricide and potential safety concerns.Fully human heavy chain variable(FHVH)antibodies that specifically target CD5 or CD7 were screened and constructed to CD5/CD7 bispecific CARs.A truncated Epidermal growth factor receptor were integrated into CAR constructs to address safety concerns.To tackle the fratricidal issue of CAR-T cells targeting T-cell-pan marker(s),CRISPR/Cas9-based CD5 and CD7 genes knockout were performed before lentiviral transduction of bispecific CARs.Functional comparison between different bispecific CAR structures:tandem CARs and dual CAR were performed in vitro and in vivo to determine the optimal construct suitable for addressing T-cell malignancy antigen escape in clinical setting.Knockout of CD5 and CD7 prevents fratricide of CD5/CD7 bispecific CAR-T cells,and FHVH-derived CD5/CD7 bispecific CAR-T cells demonstrate potent antitumor activity in vitro and in vivo.The fratricide-resistant FHVH-derived CD5/CD7 bispecific CAR-T cells have potent antitumor activity against T-cell malignancies,and tandem CARs are more effective than dual CAR in preventing tumor escape in heterogeneous leukemic cells.The meaningful clinical efficacy and safety of tandem CD5/CD7 CAR-T cells deserve to be explored urgently.