3714 research outputs found
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Revisional bariatric surgery for chronic complications necessitates custom surgical solutions
No full textBariatric surgery continues to grow as a treatment modality for obesity and weight-related comorbidities. The anatomic rearrangement can produce unique anatomic complications, as well as functional problems that are correctible with revisional operations. Understanding the unique subset of complications and the options available for correction can allow surgical solutions to be tailored to both the patient’s anatomy, and the symptoms or pathologies they are targeting. Revisional operations are becoming increasingly common, as the proportion of the general population who have previously undergone bariatric surgery continues to increase. Revisional bariatric operations are associated with an increased risk of complications and longer hospital stays, but in experienced centers can be performed safely, and often using minimally invasive approaches
The pocket-creation method of endoscopic submucosal dissection
No full textEndoscopic submucosal dissection (ESD) is rapidly becoming the standard treatment for superficial gastrointestinal tumors because ESD can achieve complete local resection facilitating thorough pathological examination of the resected specimen. The pocket-creation method (PCM) has been established to perform safe and reliable ESD obtaining a high-quality pathological specimen. A minimal mucosal incision using PCM minimizes leakage of submucosally injected solution, which results in prolonged mucosal elevation. A limited-space submucosal pocket created using PCM makes the endoscope tip stable. A conical cap, small-caliber-tip transparent (ST) hood is used when performing PCM. The submucosa can be cut along the ideal dissection line just above the muscularis with minimal thermal damage because the tip of the ST hood produces both traction and countertraction to stretch the submucosal tissue in the pocket. PCM is recommended as the standard strategy not only for colorectal ESD but also for upper-gastrointestinal ESD. It is expected that the use of traction techniques will make PCM easier to perform
Laparoscopic Heller myotomy and robotic Heller myotomy: when is it indicated?
No full textAchalasia is a primary motility disorder of unknown origin. Palliative treatment is often adopted to resolve its symptoms by eliminating the resistance due to a non-relaxing and hypertensive lower esophageal sphincter. There are three available effective treatment modalities: pneumatic dilation, laparoscopic Heller myotomy with fundoplication, and peroral endoscopic myotomy. In choosing the proper treatment, it is important to remember that the esophagus lacks peristalsis in patients with achalasia. So once the lower esophageal sphincter is eliminated, reflux may occur with the potential of causing reflux symptoms, esophagitis, peptic strictures, Barrett’s esophagus, and cancer. For this reason, we believe that laparoscopic myotomy offers the best chance in most patients of improving esophageal emptying while protecting them from abnormal reflux
Immune checkpoint inhibitor resistance in soft tissue sarcoma
No full textThe emergence of immunotherapy as a cancer therapy has dramatically changed the treatment paradigm of systemic cancer therapy. There have been several trials evaluating immune checkpoint blockade (ICI) in soft tissue sarcoma. While there is generally a limited response in sarcoma, a subset of patients has durable responses to immunotherapy. This is attributable to a variety of factors including histologic subtype, tumor-infiltrating lymphocytes, and the tumor microenvironment among others. There is ongoing translational and clinical research evaluating ICI resistance in sarcoma and identifying therapeutic strategies to overcome this resistance. Herein, we provide a review of the current data, proposed mechanisms of resistance, and potential approaches to overcome this resistance
Drug resistance in metastatic castration-resistant prostate cancer: an update on the status quo
No full textProstate cancer (PCa) is a leading cause of cancer-related morbidity and mortality in men globally. Despite improvements in the diagnosis and treatment of PCa, a significant proportion of patients with high-risk localized disease and all patients with advanced disease at diagnosis will experience progression to metastatic castration-resistant prostate cancer (mCRPC). Multiple drugs are now approved as the standard of care treatments for patients with mCRPC that have been shown to prolong survival. Although the majority of patients will respond initially, primary and secondary resistance to these therapies make mCRPC an incurable disease. Several molecular mechanisms underlie the development of mCRPC, with the androgen receptor (AR) axis being the main driver as well as the key drug target. Understanding resistance mechanisms is crucial for discovering novel therapeutic strategies to delay or reverse the progression of the disease. In this review, we address the diverse mechanisms of drug resistance in mCRPC. In addition, we shed light on emerging targeted therapies currently being tested in clinical trials with promising potential to overcome mCRPC-drug resistance
Potentials and challenges of launching the pilot phase of Hong Kong Genome Project
No full textGenomic medicine and precision medicine initiatives have taken centre stage in scientific, clinical, as well as health economics and utility research on the global scene for the past decade. It is clear the important role genomic advancement has played in enhancing diagnostic rate, streamlining personalised treatment, and improving efficacy of the overall clinical management of undiagnosed, rare, and common diseases for humankind. The Hong Kong Genome Institute (HKGI) was established in May 2020 within the Food and Health Bureau, Hong Kong Special Administrative Region, to integrate genomic medicine into mainstream healthcare. The main goals of setting up HKGI are to (1) improve the diagnostic rate and future care for individuals affected by undiagnosed diseases and hereditary cancers using whole genome sequencing; (2) advance research in genomic science; (3) nurture talents in genomic medicine; and (4) enhance public genomic literacy and overall engagement through the launching of the Hong Kong Genome Project (HKGP). In this paper, we review the current landscape and specific challenges encountered during the construction of the infrastructure and implementation of the pilot phase of HKGP. Through reviewing what has been achieved and established to date, and the potentials and prospects that have emerged in the process, this paper will provide insights into planning the main phase of HKGP, and considerations for our international counterparts when building similar projects
Exploring extracellular vesicles as mediators of clinical disease and vehicles for viral therapeutics: Insights from the COVID-19 pandemic
No full textThe COVID-19 pandemic has challenged researchers to rapidly understand the capabilities of the SARS-CoV-2 virus and investigate potential therapeutics for SARS-CoV-2 infection. COVID-19 has been associated with devastating lung and cardiac injury, profound inflammation, and a heightened coagulopathic state, which may, in part, be driven by cellular crosstalk facilitated by extracellular vesicles (EVs). In recent years, EVs have emerged as important biomarkers of disease, and while extracellular vesicles may contribute to the spread of COVID-19 infection from one cell to the next, they also may be engineered to play a protective or therapeutic role as decoys or “delivery drivers” for therapeutic agents. This review explores these roles and areas for future study
New insights of engineering plant exosome-like nanovesicles as a nanoplatform for therapeutics and drug delivery
No full textPlant exosome-like nanovesicles (PELNVs) are membrane-encapsulated nanostructures released from cells into their surroundings. PELNVs have an important role in intercellular and interspecies communication in all three domains of life. They act as protective compartments for the long-distance transit of signal molecules like proteins, nucleic acids, lipids, and other metabolites. A range of plants and vegetables can emit PELNVs. The importance of PELNVs in interspecies communication stems from their concentration in biomolecules (lipids, proteins, and miRNAs), lack of toxicity, ease of internalization by cells, and anti-inflammatory, immune-modulatory, and regenerative characteristics. PELNVs derived from numerous fruits and vegetables are biocompatible, biodegradable, and abundant in various plant species. Moreover, their convincing physicochemical characteristics underpin their modulative role in physiological and pathological processes, all of which have fueled speculation that these nanovesicles could be particularly adept at developing future-generation bio-therapeutic platforms. The goal of this review was not only to present an overview of the identified roles of PELNVs in physiology and pathology, but also to provide new insight toward their engineering for effective therapeutics and drug delivery nanoplatforms, a clue for future direction to the ongoing research gaps
Current status of the treatment of paragonimiasis
No full textParagonimiasis, a foodborne trematodiasis is caused by various Paragonimus species endemic in Asia, Africa, and the Americas. Human infection occurs through consuming improperly cooked freshwater crustaceans, crabs or crayfish, eating raw meat of paratenic hosts or by ingesting metacercariae from contaminated hands and cooking utensils. More than 292 million persons worldwide are at risk. The morbidity associated with paragonimiasis includes acute febrile illness and chronic pleuro-pulmonary manifestations which may be confounded with tuberculosis or lung cancer. Ectopic manifestations mostly involve the central nervous system, heart, or subcutaneous tissues. Objectives: to evaluate the efficacy and safety of currently available drugs praziquantel (PZQ) and triclabendazole (TCZ). Methods: a PubMed and Google Scholar search and reference selection was performed according to the the Preferred Reporting Items for Systematic Reviews protocol using a combination of the terms “paragonimiasis” AND “treatment” OR “therap*” from 01/2000 to 02/2022. Results: no randomized controlled trials were identified. Five open trials on 487 patients treated with PZQ showed 81%-100% parasite clearance depending on dosage and duration. Three open trials on 226 patients with TCZ showed a 99.6% efficacy. A quantitative comparison was not applicable to retrospective analyses of hospital records, case series and case reports because of surgical interventions, various co-morbidities and -medications and definitions of cure. Some patients treated with PZQ required multiple courses or re-treatment with TCZ, whereas one patient treated with TCZ required re-treatment with PZQ. Conclusions: PZQ and TCZ are usually effective for treating paragonimiasis. Controlled randomized trials are required to compare the safety, efficacy and applicability of PZQ versus TCZ and to evaluate combined PZQ-TCZ therapy
Electroactive organics as promising anode materials for rechargeable lithium ion and sodium ion batteries
No full textElectroactive organics have attracted significant attention as electrode materials for next-generation rechargeable batteries because of their structural diversity, molecular adjustability, abundance, flexibility, environmental friendliness and low cost. To date, a large number of organic materials have been applied in a variety of energy storage devices. However, the inherent problems of organic materials, such as their dissolution in electrolytes and low electronic conductivity, have restricted the development of organic electrodes. In order to solve these problems, many groups have carried out research and remarkable progress has been made. Nevertheless, most reviews of organic electrodes have focused on the positive electrode rather than the negative electrode. This review first provides an overview of the recent work on organic anodes for Li- and Na-ion batteries. Six categories of organic anodes are summarized and discussed. Many of the key factors that influence the electrochemical performance of organic anodes are highlighted and their prospects and remaining challenges are evaluated
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