19043 research outputs found
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Is Placenta Stem Cell Banking Worthwhile?
No full textRegenerative medicine has gained significant traction due to its potential to repair or replace damaged tissues and organs, with stem cell therapies emerging as a promising avenue for treating various diseases. While bone marrow-derived MSCs (BM-MSCs) are commonly used in clinical settings, their limitations, such as the invasive extraction procedure and limited proliferation capacity, underscore the need for alternative stem cell sources. Placenta-derived mesenchymal stem cells (PDMSCs) represent a promising solution, offering advantages such as greater proliferative capacity, faster expansion rates, and reduced risk of immune rejection compared to adult stem cells. The placenta is a rich source of MSCs, hematopoietic stem cells, and other progenitor cells. Additionally, placenta-derived cells can be cryopreserved for long-term storage and potential future use, facilitating their availability for regenerative therapies. Based on the evidence presented, private banking may be a viable option for individuals at higher risk of diseases treatable with stem cell therapy. However, for most people, the high cost and low chance of needing these stem cells make private banking an inefficient choice. Instead, considering the lack of ethical concerns surrounding the collecting of placentaderived stem cells, public stem cell banking is recommended as a beneficial alternative for broader access to potentially life-saving treatments
Physician Perspectives on Discussions Around the Sexual Health and Function of Gynecologic Cancer Patients
No full textObjectives: The primary study objective was to determine the proportion of oncology physicians treating gynecologic oncology patients screening for sexual health concerns among patients with gynecologic malignancies. The secondary objective was to describe these physicians’ perspectives on their role in evaluating sexual health concerns and barriers to managing sexual health in a gynecologic oncology office, by training level and gender. Methods: This was a cross-sectional, quantitative, 23-item survey based on a previously validated questionnaire. It was administered across the United States to physicians (attendings and fellows) treating gynecologic oncology patients using the Society of Gynecologic Oncology database. Results: There was a 10.2 % response rate with 166/1621 physicians completing the survey. Thirty-four (23.1 %) were fellow trainees and 113 (77.0 %) were attendings. Most participants were gynecologic oncologists (155/166, 93.4 %), with radiation oncologists (1/166, 0.6 %), and other physicians (10/166, 6.0 %) also responding. The majority (137/166, 82.0 %) identified as female providers and (29/166, 17.4 %) identified as male. Just over half (99/166, 59.6 %) of providers routinely asked about sexual health concerns of their patients. Attendings more often discussed sexual health with patients when compared to fellows when controlling for academic setting and gender (OR 2.8, 95 % CI 1.6–4.1, p \u3c 0.01). Most providers (117/166, 70.5 %) felt they needed to improve their knowledge on sexual function. Conclusions: Of the limited physicians surveyed, almost all feel sexual health should be discussed with their patients. Only about 59% routinely ask about sex health concerns. Future studies should focus on effective ways to incorporate sexual health screenings into gynecologic oncology clinics
A Comprehensive Review of Benign Tumors in the Lung
No full textPurpose of reviewThe purpose of this review is to provide clinicians a comprehensive overview of the epidemiology, clinical symptoms, radiological features, pathological features, and management recommendations for the vast majority of benign lung tumors. Benign lung tumors are very rare with incidence ranging from 1 in 1000 to 1 in 1 million. Despite not being malignant, certain benign tumors carry significant morbidity and mortality along with diagnostic challenges.Recent findingsAdvancements in genomic sequencing have led to discovery of mutations in particular benign lung tumors. Improved genotyping have aided the diagnosis of certain tumors and the identification of lung lesions with malignant transformation potential. Genomic understanding has also led to targeted therapy for tumors with significant morbidity.SummaryDespite radiographic and pathologic advances in understanding benign lung tumors, the paucity of cases continues to impact management recommendations and early detection. Global collaborative initiatives in compiling and analyzing cases are essential for stronger evidence based management recommendations
Spectrum of Coronary Artery Involvement With Multisystem Inflammatory Syndrome in Children versus Kawasaki Disease
No full textBACKGROUND: There is significant overlap in clinical features between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease (KD). We sought to compare the prevalence, severity, and associated factors for coronary artery (CA) involvement. METHODS AND RESULTS: From January 1, 2020 through January 31, 2023, 1191 patients with MIS-C and 554 patients contemporaneously diagnosed with KD were enrolled into the International Kawasaki Disease Registry. Demographic and clinical features, laboratory values, maximum Z score in any CA branch at any time point, and worst left ventricular ejection fraction, were compared between groups. Factors associated with CA aneurysms (maximum Z score in any CA branch +2.5 or greater) were determined separately for each diagnosis using multivariable logistic regression analyses. The prevalence of CA aneurysms was lower for MIS-C versus KD (16% versus 25%, respectively; P\u3c0.001) and less severe by size category (1.2% with medium/large CA aneurysm versus 9.6%, respectively). Male sex and lower nadir hemoglobin levels were associated with greater odds of CA aneurysms for both groups. Additional associated factors for KD patients included age\u3c6 months, fewer clinical KD criteria (more incomplete presentation), presentation with shock, and greater total days of fever. There were no additional associated factors for patients with MIS-C. Using exploratory splines, there was a trend of improvement in Z scores within 30 days of illness for both MIS-C and KD for CA involvement other than large aneurysms. CONCLUSIONS: CA involvement for patients with MIS-C was less prevalent and milder in severity compared with contemporaneous patients with KD, with fewer associated factors, and a high prevalence of regression to a normal luminal dimension
Piscirickettsia Salmonis Pathogenicity: Using the Damage-Response Framework to Look Beyond Smoke and Mirrors
No full textPiscirickettsia salmonis is a globally distributed aquatic bacterium and a component of the normal salmon microbiome. It has significant biological and economic impact on Chilean salmon aquaculture due to the highly fatal disease, piscirickettsiosis. Unsuccessful attempts to prevent and treat this disease have resulted in heavy use of antimicrobials with adverse effects on the aquatic environment and piscine and human health. Evidence suggests P. salmonis could be a bacterium with relative pathogenic potential on farmed salmonids and other fishes that triggers piscirickettsiosis under particular conditions in the salmon and its environment. Application of a damage-response framework analysis could define the steps from asymptomatic P. salmonis infection to symptomatic disease, help tailor improved approaches to disease prevention and management, and, in turn, help avoid heavy use of antimicrobials which have global effects on animal health, human health, and environmental biodiversity (the One Health concept)
Long Working Hours and Cardiovascular Risk: A Call for Focus on Healthcare Professionals
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The Survey of Barriers for Vaginal Access Surgery Study
No full textStudy Objective: The primary objective of this study was to describe vaginal hysterectomy practice patterns as well as facilitators and inhibitors to performing vaginal hysterectomy among gynecologic surgeons. Secondary objectives were to describe facilitators and inhibitors to the teaching and training of vaginal hysterectomy. Design: A quantitative analysis of an online survey and qualitative analyses of the one-on-one interviews with gynecologic surgeons were conducted. This study was approved by the institutional review board. Setting: Online survey and one-on-one virtual interviews. Patients: Members of the American Association of Gynecologic Laparoscopists and the Society of Gynecologic Surgeons. Interventions: None. Measurements and Main Results: A total of 505 gynecologic surgeons completed the survey. Most surgeons were white (66.9%) and had a clinic in North America (67.5%). Approximately 48% of respondents reported “no barrier” to performing vaginal hysterectomies including pathology, visualization and exposure, and performance of concomitant procedures. Higher surgical volume was the only factor most commonly rated by surgeons as enabling the teaching of vaginal hysterectomy “quite a bit” (31.3%). Most surgeons agreed that vaginal hysterectomies are important to women\u27s health (82.8%) and that all gynecologic surgeons should be able to perform vaginal hysterectomies (66.3%). In terms of medical education and training, most surgeons thought that residents should be required to achieve competency for vaginal hysterectomy before graduation (71.7%) and disagreed (56.0%) that we should eliminate residency graduation requirements for vaginal hysterectomy numbers. From the one-on-one interviews, major themes identified included advocacy, centralizing efforts, compensation and incentives, cycle of low experience, decreasing regional trends, lack of industry support, transvaginal vs laparoscopy culture, varied training targets and resources, innovations in training, and self-motivation. Conclusions: Vaginal hysterectomy remains important to our field. Identified barriers and major themes from this study can direct future efforts to increase its adoption
Factors Associated With Shock at Presentation in Kawasaki Disease versus Multisystem Inflammatory Syndrome in Children Associated With Covid-19
No full textBackground: While clinical overlap between Kawasaki disease (KD) and multisystem inflammatory syndrome in children (MIS-C) has been evident, information regarding those presenting with shock has been limited. We sought to determine associations with shock within and between diagnosis groups. Methods: The International KD Registry enrolled contemporaneous patients with either KD or MIS-C from 39 sites in 7 countries from January 1, 2020, to January 1, 2023. Demographics, clinical features and presentation, management, laboratory values, and outcomes were compared between the diagnosis and shock groups. Results: Shock at presentation was noted for 19 of 672 KD patients (2.8%) and 653 of 1472 MIS-C patients (44%; P \u3c 0.001). Within both groups, patients with shock were significantly more likely to be admitted to the intensive care unit, to receive inotropes, and to have greater laboratory abnormalities indicative of hyperinflammation and organ dysfunction, including abnormal cardiac biomarkers. Patients with KD and shock had a greater maximum coronary artery z score (median +2.62) vs KD patients without shock (+1.36; P \u3c 0.001) and MIS-C patients with shock (+1.45 [vs +1.32 for MIS-C patients without shock]; P \u3c 0.001). They were also more likely to have large coronary artery aneurysms. In contrast, MIS-C patients with shock had lower left ventricular ejection fraction (mean 51.6%) vs MIS-C patients without shock (56.6%; P \u3c 0.001) and KD patients with shock (56.7% [vs 62.8% for KD patients without shock]; P = 0.04). Conclusions: Although patients with KD presenting with shock are clinically similar to patients with MIS-C, especially those with shock, they have more severe coronary artery involvement, whereas MIS-C patients with shock have lower left ventricular ejection fraction
Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With a D5W Push Technique: A Multicentric North American Study of 269 Patients
No full textBACKGROUND AND OBJECTIVES:As the aging population increases, the incidence of chronic subdural hematomas (cSDHs) is expected to rise. Surgical evacuation, though effective, sees up to 30% recurrence. Middle meningeal artery (MMA) embolization, particularly with n-butyl cyanoacrylate (n-BCA) glue diluted in D5W for distal penetration, has shown promise in reducing recurrences. Limited reports have investigated the safety and technical feasibility of n-BCA as a primary liquid embolic agent using the D5W push technique in cSDH. This series is the largest in the literature investigating the outcomes of this technique in cSDH.METHODS:A multicenter retrospective database analysis was conducted on consecutive patients who underwent MMA embolization using n-BCA embolisate. Data collected included patient demographics, procedural information, angiographic data, and periprocedural complications.RESULTS:The study included 269 patients with a median age of 76 years. Nearly half of the patients had previous surgeries, and 93 underwent contralateral embolization for bilateral cSDH. Successful MMA embolization with effective distal penetration was achieved in all cases. The complication rate was 2.2%. Significant improvements were noted at a 60-day follow-up, with a median reduction in cSDH diameter of 40.6% (P \u3c.001) and 53% of patients showing neurological improvement. No recurrent cSDH or need for retreatment was observed in patients who underwent follow-up.CONCLUSION:MMA embolization using n-BCA with the D5W push technique is safe and technically feasible. It can be used adjunctively or as an alternative to surgery in patients with cSDH, resulting in decreased recurrence, high technical success, improved distal penetration, and low complication rates