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Battling Infertility
No full textInfertility is a complex condition that affects men and women equally and is defined by failure to achieve pregnancy after a year of trying to conceive. This paper addresses both environmental contributions to infertility, such as the effects of smoking, poor nutrition, and exposure to radiation, as well as biological contributors. Biological factors that contribute to infertility include sperm DNA fragmentation, chromosomal mutations, anovulatory dysfunction, and tubule blockages. This paper delves into various treatment options to improve fertility in both males and females, including medications, lifestyle adaptations, and surgeries. These treatment options can restore and improve ovulatory function, sperm motility and quality, hormonal balance, and regulate metabolic functions. Emerging research in nanotechnology and ovarian tissue preservation are also discussed as promising developments to treat infertility. Additionally, the paper emphasizes critical considerations such as age, finances, physical pain, and emotional stress while evaluating and selecting infertility treatments. This research paper examines multiple studies and treatments for infertility, aiming to educate and provide infertile couples with the best options to achieve parenthood
The Current Understanding of the Molecular Pathogenesis of Papillary Thyroid Cancer
No full textThe thyroid is a vital endocrine organ that regulates metabolism, heart rate, respiration, digestion, body temperature, brain development, skin and bone maintenance, and reproduction and fertility. Thyroid cancer (TC) is the most common endocrine malignancy, with an estimate of 44,020 new cases in 2025. Incidence has been increasing, most notably at 4–5% per year in young adults. Papillary thyroid cancer (PTC), the most common TC subtype, accounts for approximately 80% of newly diagnosed TC cases. Furthermore, 2290 deaths are expected from the disease in 2025, with survival at over 98% with treatment. However, as PTC occurs most frequently in young women, recurrences are frequent and the 10-year disease-specific survival rate for advanced PTC is less than 50%. This narrative review aims to describe the current understanding of the thyroid gland, the incidence and subtypes of thyroid cancer, and specifically the diagnosis, prognosis, treatment, and recurrence of PTC. This is supplemented by the role of molecular pathways and biomarkers in PTC
Correction To: Fecal Immunochemical Testing for Colorectal Cancer Prevention in Two Public Hospitals (Journal of Gastrointestinal Cancer, (2025), 56, 1, (69), 10.1007/S12029-025-01187-Y)
No full textRecently Published the Article “Fecal Immunochemical Testing for Colorectal Cancer Prevention in Two Public Hospitals https://doi.org/10.1007/s12029-025-01187-y” on Journal of Gastrointestinal Cancer. We would like to reach out for 2 issues: Correction in DiscussionIn this article, we cited a Danish study on adherence to colonoscopy at the end of Paragraph 4 of Discussion.“Our study revealed that despite these advantages, adherence remains a major obstacle in CRC screening with FIT. Previous studies in the Midwest of the US, California, China, and Denmark also reported a similar colonoscopy adherence rate of 40–50% after a positive FIT [33–36].”The citation 34 is the Danish study:“34. Jørgensen SF, Larsen PT, Erichsen R, Andersen B, Rebolj M, Njor S. Adherence to follow-up and resource use after abnormal FIT-screening: evaluation of the Danish colorectal cancer screening program. Endosc Int Open. 2024;12(5):E649-e658.”The correct statement should be“Previous studies in the Midwest of the US, California, and China also reported a similar colonoscopy adherence rate of 40–50% after a positive FIT.”The citation 34 should also be removed.We sincerely apologize for this mistake. Please kindly let us know if further actions should be taken from our side Figure accuracyFigure 1 of the published article did not look like the submitted figure. The lines and boxes are absent and only the texts are present. We uploaded the correct files in both pdf and jpg format. Correction in Discussion In this article, we cited a Danish study on adherence to colonoscopy at the end of Paragraph 4 of Discussion. “Our study revealed that despite these advantages, adherence remains a major obstacle in CRC screening with FIT. Previous studies in the Midwest of the US, California, China, and Denmark also reported a similar colonoscopy adherence rate of 40–50% after a positive FIT [33–36].” The citation 34 is the Danish study: “34. Jørgensen SF, Larsen PT, Erichsen R, Andersen B, Rebolj M, Njor S. Adherence to follow-up and resource use after abnormal FIT-screening: evaluation of the Danish colorectal cancer screening program. Endosc Int Open. 2024;12(5):E649-e658.” The correct statement should be “Previous studies in the Midwest of the US, California, and China also reported a similar colonoscopy adherence rate of 40–50% after a positive FIT.” The citation 34 should also be removed. We sincerely apologize for this mistake. Please kindly let us know if further actions should be taken from our side Figure accuracy Figure 1 of the published article did not look like the submitted figure. The lines and boxes are absent and only the texts are present. We uploaded the correct files in both pdf and jpg format. The original article has been corrected
Implantation of a Temporary Microaxial Left Ventricular Assist Device via the Right Axillary Artery in a Patient With Aberrant Right Subclavian Artery
No full textA temporary microaxial left ventricular assist device is commonly implanted via the right axillary artery to treat decompensated heart failure or cardiogenic shock. However, limited literature describes implantation in a variant aortic arch anatomy setting. We present a case of implantation via the right axillary artery in a patient with an aberrant right subclavian artery (Arteria Lusoria) as a bridge to heart transplantation
Survey of NCI-Designated Cancer Centers on the Utilization of Palliative Care in Pancreatic Cancer Patients
No full textRecognized as one of the deadliest cancers, pancreatic cancer underscores an urgent need for palliative care. We surveyed palliative care directors at all 65 National Cancer Institute (NCI) cancer centers to assess the utilization and timing of palliative care involvement in pancreatic cancer patients. 1) Does your palliative care team have a policy to get involved with every pancreatic cancer patient? a. Yes b. No 2) When palliative care is involved with pancreatic cancer patients, in what setting are you typically/primarily first asked to be involved? a. Early in the patient’s treatment journey (focusing on symptom management) b. Later in the patient’s treatment journey (focusing on end-of-life discussions and explaining hospice) All 65 NCI-designated centers responded, achieving 100% of the targeted sample. Among these centers, 64 lacked a policy for palliative care involvement with every pancreatic cancer patient. Additionally, 38 centers initiated intervention early, focusing on symptom management, while 15 centers started palliative care late in the treatment journey, emphasizing end-of-life discussions. Furthermore, 12 centers initiated intervention both early and late when treating pancreatic cancer. There is an increasing recognition among medical centers of palliative care’s necessity for pancreatic cancer, with a rising trend toward early integration. Variation in the timing and emphasis of palliative care involvement remains. Future research should explore barriers to accessing palliative care and compare outcomes of early versus late intervention. By addressing these areas, healthcare providers can potentially improve outcomes for pancreatic cancer patients
Utility of Revised Risk Analysis Index as a Predictor of Mortality and Morbidity in Orthopaedic Trauma
No full textObjectives:The aim of this study was to determine the applicability of the Revised Risk Analysis Index (RAI-Rev) in orthopaedic trauma and compare the predictive discrimination for the RAI-Rev and the 5-Item Modified Frailty Index (mFI-5) for 30-day postoperative outcomes.Methods:Design:This is a retrospective cohort study.Setting:The American College of Surgeons National Surgical Quality Improvement database was used.Patient Selection:All patients aged 18 or older who underwent surgical treatment for forearm, humerus, pelvis, acetabulum, femur, tibia, and hindfoot fractures from 2015 to 2020 were included.Outcome:30-day postoperative mortality, major complications, and wound complications consisting of surgical site infection, and wound dehiscence were measured.Results:A total of 206,352 patients met inclusion criteria. The mean age was 69 years, with 64.2% (n = 132,514) being female. Multivariate regression analysis showed that increasing frailty tiers in both RAI-Rev and mFI-5 were independent predictors of mortality, major complications, readmission, and wound complications. The cohort with the highest degree of frailty in both RAI-Rev and mFI-5 had the greatest risk of poor outcomes. RAI-Rev had significantly superior predictive discriminatory thresholds compared with mFI-5 for predicting 30-day mortality (C-statistic: RAI-Rev [0.84] and mFI-5 [0.67], P \u3c 0.001), major complications (C-statistic: RAI-Rev [0.73] and mFI-5 [0.65], P \u3c 0.001), and readmission (C-statistic: RAI-Rev [0.68] and mFI-5 [0.63], P \u3c 0.001). However, mFI-5 outperformed RAI-Rev when predicting wound complications (C-statistic: RAI-Rev [0.52] and mFI-5 [0.55], P \u3c 0.001).Conclusion:The RAI-Rev tool demonstrated superior predictability of postoperative morbidity, mortality, and readmission rates compared with mFI-5 but was less effective in predicting surgical site complications. These findings demonstrate the utility of RAI-Rev in anticipating postoperative complications in the setting of orthopaedic trauma, where optimizing surgical candidate selection is not always possible. Assessing the predicted morbidity and mortality through RAI-Rev enables surgeons to accurately identify patients at high risk of complications, which can further research investigation to mitigate this risk
Evaluating the Accuracy of Patient-Reported Hair Outcomes versus Trichometric Measurements in PRP Therapy
No full textMonitoring both subjective and objective responses to alopecia treatment is critical for assessing patient perception and therapeutic efficacy. Platelet-rich plasma (PRP) therapy is a widely used treatment for alopecia, particularly androgenetic alopecia (AGA), yet the correlation between patient-reported outcomes and trichometric measurements remains poorly defined. This retrospective study analyzed data from 56 alopecia patients treated with PRP at NYU Langone Health between November 2017 and March 2025. Patients were categorized as “improved,” “stable,” or “worse” based on self-assessments, and changes in hair density and width were evaluated over the course of PRP treatment. Spearman’s rank correlation and Kruskal-Wallis Rank Sum Tests were used for statistical analysis. Results showed that patient-reported outcomes correlated significantly with changes in hair density (p = 0.0006), but not hair width (p = 0.2688). The greatest increase in hair density was observed in the “improved” group (+ 18.9 hairs/cm²), with a more modest gain in the “stable” group (+ 7.6 hairs/cm²), while the “worse” group experienced a decrease (− 19.7 hairs/cm²). Differences in density across all three groups were statistically significant (p = 0.0012), whereas width changes were not (p = 0.5009). Subgroup analysis of AGA patients yielded similar findings. These results suggest that patient perception aligns more closely with density changes than width changes. Combining subjective assessments with objective measurements enhances clinical decision-making, expectation management, and holistic evaluation of PRP treatment efficacy in alopecia patients
Bridging the Gap: A Systematic Review of Intraoperative Electrocochleography During Cochlear Implantation and Preservation of Residual Hearing
No full textCochlear implantation is a surgical intervention to provide auditory rehabilitation to individuals with severe to profound hearing loss. Intraoperative electrocochleography (ECochG) has emerged as a promising tool for monitoring cochlear health during cochlear implant (CI) surgery. This systematic review aims to synthesize current evidence regarding the effectiveness of intraoperative ECochG in predicting postoperative residual hearing levels in CI recipients. A comprehensive literature search was conducted across major databases including PubMed, Embase, Web of Science, and SCOPUS. The protocol for this systematic review was registered in the PROSPERO database (registration number: CRD42023476617). The key outcomes assessed were the correlation between intraoperative ECochG patterns and postoperative residual hearing levels, as well as the influence of surgical techniques and electrode design on ECochG responses and hearing preservation. The Risk of Bias analysis was conducted using the Joanna Briggs Institute Critical Appraisal Tool. The review included a total of eighteen studies that met the inclusion and exclusion criteria. A significant correlation was reported between specific intraoperative ECochG response patterns and the preservation of residual hearing post-surgery. Studies highlighted that robust ECochG responses typically indicated a higher likelihood of postoperative hearing preservation. The review also identified factors influencing ECochG responses, including electrode design and insertion techniques. Several studies reported improved preservation of residual hearing with modifications in surgical approaches guided by ECochG feedback. Intraoperative ECochG monitoring emerges as a crucial tool in predicting and potentially enhancing postoperative residual hearing outcomes in implanted individuals. The review underscores the value of ECochG in guiding surgical technique adjustments, thereby maximizing hearing preservation. However, the heterogeneity in study designs and ECochG protocols suggests a need for standardization in this field. Future research should focus on large-scale, multicenter trials to establish definitive guidelines for integrating ECochG in CI surgeries, with an emphasis on long-term hearing outcomes
Letter to the FDA Proposing Major Changes in the US Clozapine Package Insert Supported by Clozapine Experts Worldwide. Part I a Review of the Pharmacokinetic Literature and Proposed Changes
No full textPurpose/Background: Clozapine was approved in the United States (US) using 1989 regulations and knowledge. After 30 years, many sections of the US package insert (PI) are outdated. Methods: We comprehensively reviewed the literature to propose PI updates. We present the information in 2 articles. In Part I, we focus on basic pharmacology based on 407 relevant articles. Part II focuses on clinical aspects and pharmacovigilance. Findings/Results: Based on more recent expectations of Food and Drug Administration regulations, we reviewed clozapine basic pharmacology including the following: 1) clearance, 2) pharmacokinetics and pharmacodynamics, and 3) monitoring tools. We identified 9 major problems in the basic pharmacological sections of the PI including the following: 1) in vivo studies indicate that clozapine is dependent on CYP1A2 for its metabolism, 2) the minor role of CYP2D6 in clozapine metabolism requires removing the PI recommendation to lower clozapine doses in CYP2D6 poor metabolizers, 3) in nontoxic concentrations CYP3A4 has a minor role in clozapine metabolism and potent CYP3A4 inhibitors lack clinically relevant effects, 4) several drug-drug interactions need to be updated based on recent literature, 5) systemic inflammation may decrease clozapine metabolism and increase the risk of clozapine intoxication, 6) obesity may decrease clozapine metabolism, 7) patients of Asian and Indigenous American ancestry need lower clozapine doses, 8) personalized titration and c-reactive protein monitoring should be considered until prospective studies are available, and 9) the half-life section needs to be modified to acknowledge that single dosing at night is frequent in the US. Implications/Conclusions: An improvement in the US clozapine PI may lead to improvement in PIs worldwide
Insight Into the Anti-Allergic Impacts of Fucoidan From Gracilaria Lemaneiformis in Mitigating Allergic Reactions Induced by Shrimp Tropomyosin via Regulating Th1/Th2 Cytokines and T Cell Subsets
No full textFucoidan is a natural sulfated polysaccharide with immunoregulatory function. In this work, the anti-allergic impacts of Gracilaria lemaneiformis fucoidan (GLF) in mitigating allergic reactions induced by shrimp tropomyosin were investigated. As the results, GLF performed significant hyaluronidase inhibition ability (IC50 = 0.272 mg/mL), alleviated the allergic reactions of RAW 264.7 macrophage cells via decreasing the secretion of TNF-α and NO by 58.75 % and 46.17 %, respectively, and mitigated the degranulation degree and secretion of IL-4, TNF-α and histamine as well as promoted IL-10 secretion in RBL-2H3 mast cells. In BALB/c mouse, after gavage of GLF, the mouse allergic symptoms got significantly alleviated, the secretion of IgE and IgG1 got reduced, IgG2a got promoted, the IL-4 secretion from mouse spleen lymphocytes (SLP) significantly declined, and IL-10 and IFN-γ secretion in SLP got improved, which indicated GLF performed significantly anti-allergic functions via transforming Th2 response into Th1 and Treg response. Moreover, the SLP cells treated by GLF had lower expression of GATA-3, higher T-bet and Foxp3 expression, which indicated GLF could mitigate allergic reactions via regulating T-bet, GATA3 and Foxp3 transcription factor expression of T cell subsets. Therefore, GLF could serve as anti-allergic substances for shrimp-induced allergy via regulating Th1/Th2 cytokines and T cell subsets