3714 research outputs found
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Ultrasound liver map technique for laparoscopic liver resections: tips and tricks
No full textLaparoscopic liver resection (LLR) is safer and more advantageous than open surgery regarding morbidity, blood loss, and length of hospital stay. Several radiological studies and liver surgical strategies confirmed that the anatomy of the liver is more complex than what Couinad described. Intraoperative ultrasound (IOUS) has become an indispensable tool to identify the “real anatomy” and to plan a tailored LLR because of wide sub-segmentary variability and lack of external indicators for small functional liver cores. We schematized our standard ultrasound guidance technique during anatomical and non-anatomical LLR as a four-step method called the Ultrasound Liver Map Technique: (1) Compose the three-dimensional mind map to study the relationships between lesions and surrounding vascular elements; (2) create a sketch on the Glissonian using cautery to help the surgeon recall the mind liver anatomy map; (3) check the section plane while proceeding with the transection; and (4) correct the direction of resection plan to ensure a healthy margin concerning the lesion and to point out the pedicle section correctly and not affected structures. Finally, IOUS-Doppler can be used to study the segmental portal flow to assess venous drainage of the remnant parenchyma, avoiding ischemia and increasing the possibility of performing parenchyma-sparing surgery
The change of paradigm in the treatment of HER2-positive breast cancer with the development of new generation antibody-drug conjugates
No full textHER2-positive breast cancer is an aggressive disease. As a result of the development of specific HER2-targeted therapies, such as trastuzumab, more than 20 years ago, the prognosis of these patients has improved. Metastatic HER2-positive breast cancer patients are achieving better survival rates upon treatment with anti-HER2 therapies than patients with HER2-negative disease. Double HER2 blockade with trastuzumab and pertuzumab combined with a taxane achieved an unprecedented survival of over 57 months in first-line patients. Trastuzumab emtansine, the first antibody-drug conjugate approved for patients in second-line treatment was a potent cytotoxic agent bound to trastuzumab and is currently a standard therapeutic strategy. Despite the progress in treatment development, most patients develop resistance and eventually relapse. Advances in the design of antibody-drug conjugates have led to the development of new generation drugs with enhanced properties, such as trastuzumab deruxtecan and trastuzumab duocarmazine, which are significantly changing the paradigm in the treatment of HER2-positive metastatic breast cancer
Liver fibrosis in nonalcoholic fatty liver disease patients: noninvasive evaluation and correlation with cardiovascular disease and mortality
No full textLiver fibrosis is critical for liver-related outcomes and mortality in chronic liver disease, irrespective of etiology, including nonalcoholic fatty liver disease (NAFLD). NAFLD has been viewed as an independent correlate of cardiovascular risk. This review article briefly describes the cellular and molecular pathomechanisms underlying hepatic fibrosis. We then address noninvasive assessment of liver fibrosis. Finally, we discuss published evidence supporting fibrosis biomarkers’ role in assessing cardiovascular risk among patients with NAFLD. While histological assessment is the diagnostic standard of hepatic fibrosis, we specifically address noninvasive techniques, including equations based on anthropometric parameters, laboratory indices, and elastometry obtained with imaging techniques. The former group includes AST: ALT ratio, the Forns Index, the AST-to-platelet ratio index score, BARD (BMI, AAR, Diabetes) score, the fibrosis-4 index (FIB-4), the NAFLD fibrosis score, the gamma-glutamyl transferase-to-platelet ratio, and the Hepamet fibrosis score. The latter comprises elastographic techniques associated with ultrasonography or magnetic resonance. Our literature review identified numerous studies demonstrating that biomarkers of fibrosis (the most common being FIB-4) and elastographic techniques predict overall mortality and major cardiovascular events among NAFLD patients. The mechanisms accounting for this association are briefly reviewed. In addition to assessing hepatic fibrosis at baseline, during follow-up, and after therapeutic interventions in NAFLD patients, noninvasive assessment of hepatic fibrosis may predict cardiovascular events and overall mortality in these patients
Elastic properties and Ion-mediated domain switching of self-assembled heterostructures CuInP2S6-In4/3P2S6
No full textVan der Waals (vdW) ferroelectric CuInP2S6 (CIPS) has attracted intense research interest due to its unique ferroelectric properties that make it promising for potential applications in flexible electronic devices. A mechanical mean, or so-called strain gradient engineering, has been proven as an effective method to modulate its ferroelectric properties, but the key parameter elastic constants Cij has not been accurately measured. Here, we utilized nanoindentation and contact resonance atomic force microscopy (CR-AFM) techniques to measure the elastic modulus on the (001) plane of nanoscale phase separated CuInP2S6-In4/3P2S6 (CIPS-IPS). The Young’s modulus of the CIPS was slightly less than that of the IPS. Density Functional Theory was introduced to obtain the accurate full elastic constant Cij of CIPS and IPS, and we deduced their respective Young’s moduli, all of which are in good agreement with our experimental values. We further discovered the asymmetrical domain switching and proposed an ion-mediated domain switching model. The results provide a reliable experimental reference for strain gradient engineering in the phase field simulation in CIPS-IPS
What ails the NIH peer review study sections and how to fix the review process of the grant applications
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In vitro human gut microbiota fermentation models: opportunities, challenges, and pitfalls
No full textThe human gut microbiota (HGM) plays a pivotal role in health and disease. Consequently, nutritional and medical research focusing on HGM modulation strategies as a means of improving host health is steadily increasing. In vitro HGM fermentation models offer a valid complement to human and animal studies when it comes to the mechanistic exploration of novel modulation approaches and their direct effects on HGM composition and activity, while excluding interfering host effects. However, in vitro cultivation of HGM can be challenging due to its high oxygen sensitivity and the difficulties of accurately modeling the physio-chemical complexity of the gut environment. Despite the increased use of in vitro HGM models, there is no consensus about appropriate model selection and operation, sometimes leading to major deficiencies in study design and result interpretation. In this review paper, we aim to analyze crucial aspects of the application, setup and operation, data validation and result interpretation of in vitro HGM models. When carefully designed and implemented, in vitro HGM modeling is a powerful strategy for isolating and investigating biotic and abiotic factors in the HGM, as well as evaluating their effects in a controlled environment akin to the gut. Furthermore, complementary approaches combining different in vitro and in vivo models can strengthen the design and interpretation of human studies
Artificial intelligence in plastic surgery: current developments and future perspectives
No full textDriven by the rapid development of big data, the amount of clinical data, including complex information, is expanding. Traditional data analysis methods cannot meet the need for mining data information, and artificial intelligence (AI) solves this problem. AI is increasingly being incorporated into modern medical practice. Algorithms provided by AI support advanced analysis and provide individualized aid to optimize medical decision-making. In plastic surgery, AI has made many breakthroughs in diagnosis, pre-operative surgical design, treatment decisions, and patient management. Plastic surgeons must recognize AI’s potential development and limitations. This review describes the current application of AI in plastic surgery and discusses the challenges and problems that need to be solved. This study aims to foster the application of this new AI technology in clinical practice
Endocrine therapy in metastatic breast cancer-more than just CDK4/6 inhibitors
No full textAdvanced hormone receptor-positive breast cancer is one of the women’s most common malignant diseases and remains incurable despite recent therapeutic innovations. The dependence of hormone receptor-positive breast cancer on hormonal growth signals offers the possibility of inhibiting this signaling pathway using anti-hormonal therapy. Nevertheless, the development of resistance to antitumoral drugs remains a challenge. Molecularly-targeted substances significantly improve survival rates and (as in the case of cyclin-dependent kinase 4 and 6 inhibitors) are widely used in clinical practice and enhance endocrine therapy’s efficacy. Agents such as everolimus, alpelisib, and capivasertib target the phosphoinositide 3 kinase/protein kinase B/mammalian target of rapamycin pathway, which is a promising approach to overcoming endocrine resistance. Novel therapies are being studied in numerous trials, and some already show significant benefits in survival rates. The development of new therapies to avert endocrine resistance is an urgent challenge in modern medicine. The following review will examine some promising therapeutic approaches
Recent advances in nonmetallic modulation of palladium-based electrocatalysts
No full textModulating the electrocatalytic performance of Palladium (Pd) with nonmetallic elements (e.g., H, B, C, N, O, P and S) has gained ever-increasing attention since their introduction has been proven to effectively modulate the 3d-electronic configuration and subsurface properties of Pd. In this review, the most advanced nonmetal-modified Pd-based catalysts are classified according to the different doped atoms (i.e., hydrides, borides, carbides, nitrides, oxides, phosphides and sulfides) and critically reviewed to emphasize the roles of nonmetallic elements doping on various electrocatalytic reactions. In each section, the synthetic strategies developed to incorporate nonmetals are discussed in detail. Furthermore, the optimized approaches of nonmetals-doped Pd-based catalysts and corresponding electrocatalytic enhancement mechanisms are also discussed clearly. Finally, the current challenges and future perspectives regarding nonmetal-modified Pd-based nanocatalysts are also outlined
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