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Haematologic outcomes and associated clinical characteristics among patients receiving Olaparib therapy in the UAE: a retrospective chart review.
Pub Date : 2025-12-01 Epub Date: 2024-12-13 DOI: 10.1080/07853890.2024.2440631
Lina Wahba, Said Nabil, Saba Kendakji, Mariam Ibrahim, Sham ZainAlAbdin, Salahdein Aburuz, Amal Akour

Background: Poly ADP ribose polymerase (PARP) inhibitors, such as Olaparib (Lynparza®), are pivotal in treating certain cancers, particularly those linked to BReast CAncer gene (BRCA) mutations. Despite its established efficacy, Olaparib use is associated with various adverse events (AEs), notably haematologic toxicities, such as anaemia. This retrospective chart review study aimed to examine haematologic outcomes and associated factors in patients treated with Olaparib at a tertiary hospital in the UAE.

Methods: We reviewed the medical charts of patients prescribed Olaparib and focused on haematologic indices at a baseline of 1-month, 3-month and 6-month follow-up periods. Data were analysed to determine the AEs frequency, transfusions need and potential associated patients' clinical characteristics.

Results: This study included all patients who received Olaparib (n = 66). Most patients were females (n = 61; 92.4%) and the vast majority were non-smokers (97%) and free of hepatic disease. Themean age of the patients was 57.03-year-old (SD) = 12.06 years), and body mass index (BMI) was 28.16 (SD = 6.40) kg/m2. A high rate of anaemia (70.8%) was detected among the patients during their Olaparib therapy. Approximately, one-third of the patients developed neutropenia and thrombocytopenia. Transfusion was needed in almost half of the patients. Glomerular filtration rate (GFR) and neutropenia were significantly correlated with moderate-severe anaemia (OR = 0.097, 95% CI: 0.011-0.88, p value = .038) and (OR = 9.04, 95% CI: 1.024-79.78, p value = .048), respectively.

Conclusions: Our findings highlight the side effects of Olaparib therapy in terms of haematology which could be avoided. Further studies are needed to better understand the therapeutic management of Olaparib and the mitigation of haematologic complications.

背景:聚ADP核糖聚合酶(PARP)抑制剂,如奥拉帕利(Lynparza®),在治疗某些癌症,尤其是与乳腺癌基因(BRCA)突变有关的癌症方面起着关键作用。尽管奥拉帕利具有公认的疗效,但它的使用与各种不良事件(AEs)有关,尤其是血液学毒性,如贫血。这项回顾性病历研究旨在考察阿联酋一家三级医院中接受奥拉帕利治疗的患者的血液学结果及相关因素:我们回顾了奥拉帕利处方患者的病历,重点关注1个月、3个月和6个月随访期间的血液学指标。我们对数据进行了分析,以确定AEs频率、输血需求以及可能相关的患者临床特征:本研究纳入了所有接受奥拉帕利治疗的患者(66 人)。大多数患者为女性(n = 61;92.4%),绝大多数患者不吸烟(97%)且无肝病。患者的平均年龄为 57.03 岁(SD = 12.06 岁),体重指数(BMI)为 28.16(SD = 6.40)kg/m2。在奥拉帕尼治疗期间,患者的贫血率很高(70.8%)。约三分之一的患者出现中性粒细胞减少和血小板减少。近一半的患者需要输血。肾小球滤过率(GFR)和中性粒细胞减少分别与中重度贫血(OR = 0.097,95% CI:0.011-0.88,p 值 = .038)和(OR = 9.04,95% CI:1.024-79.78,p 值 = .048)显著相关:我们的研究结果凸显了奥拉帕利治疗在血液学方面的副作用,这些副作用是可以避免的。为了更好地了解奥拉帕利的治疗管理和减轻血液学并发症,还需要进一步的研究。
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引用次数: 0
Proteomic analysis for busulfan-induced spermatogenesis disorder.
Pub Date : 2025-12-01 Epub Date: 2024-12-19 DOI: 10.1080/07853890.2024.2442534
Ke Hu, Qinran Zhu, Jiaqi Zou, Xin Li, Min Ye, Jing Yang, Sixieyang Chen, Fan Li, Biao Ding, Shuai Yang, Chuanwang Song, Meng Liang

Background: Busulfan is the most commonly used drug for the treatment of chronic myelogenous leukemia and pretreatment for hematopoietic stem cell transplantation, which can damage the reproductive and immune system. However, little is known about the protein expression profiling in busulfan treated testis.

Methods: This research studies the proteomics for busulfan-induced spermatogenesis disorder. The model of busulfan-induced mouse spermatogenesis disorder was subjected to label-free quantification proteomics analysis. Clustering heatmap, gene ontology, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and protein interaction analyses were performed and validated by molecular experiments.

Results: The busulfan-treated mouse model showed abnormal testis morphology and reduced sperm number and testis weight. Testicular and sperm damage was most severe at 30 days after busulfan treatment. The busulfan-treated mouse testes were subjected to label-free quantification proteomics, which revealed 190 significantly downregulated proteins including lactate dehydrogenase A like 6B (LDHAL6B) and ubiquitin-specific protease 7 (USP7). In addition, the testis and spermatozoa in the epididymis progressively improved from 70 to 80 days after busulfan treatment, and that the testis weight and spermatozoa number gradually increased from 40 to 80 days after busulfan treatment. Western blotting revealed that LDHAL6B protein significantly increased at 10 days, decreased from 20 to 60 days, and then gradually elevated from 70 to 80 days after busulfan treatment.

Conclusion: We revealed 190 significantly downregulated proteins in busulfan-treated mouse testes at 30 days and indicated that 70 days is the cut-off point of spermatogenic recovery for busulfan-treated mouse testis, increasing our understanding of this reproductive disorder model. An increased understanding of busulfan's toxic effect will help to prevent and treat reproductive diseases.

{"title":"Proteomic analysis for busulfan-induced spermatogenesis disorder.","authors":"Ke Hu, Qinran Zhu, Jiaqi Zou, Xin Li, Min Ye, Jing Yang, Sixieyang Chen, Fan Li, Biao Ding, Shuai Yang, Chuanwang Song, Meng Liang","doi":"10.1080/07853890.2024.2442534","DOIUrl":"https://doi.org/10.1080/07853890.2024.2442534","url":null,"abstract":"<p><strong>Background: </strong>Busulfan is the most commonly used drug for the treatment of chronic myelogenous leukemia and pretreatment for hematopoietic stem cell transplantation, which can damage the reproductive and immune system. However, little is known about the protein expression profiling in busulfan treated testis.</p><p><strong>Methods: </strong>This research studies the proteomics for busulfan-induced spermatogenesis disorder. The model of busulfan-induced mouse spermatogenesis disorder was subjected to label-free quantification proteomics analysis. Clustering heatmap, gene ontology, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway and protein interaction analyses were performed and validated by molecular experiments.</p><p><strong>Results: </strong>The busulfan-treated mouse model showed abnormal testis morphology and reduced sperm number and testis weight. Testicular and sperm damage was most severe at 30 days after busulfan treatment. The busulfan-treated mouse testes were subjected to label-free quantification proteomics, which revealed 190 significantly downregulated proteins including lactate dehydrogenase A like 6B (LDHAL6B) and ubiquitin-specific protease 7 (USP7). In addition, the testis and spermatozoa in the epididymis progressively improved from 70 to 80 days after busulfan treatment, and that the testis weight and spermatozoa number gradually increased from 40 to 80 days after busulfan treatment. Western blotting revealed that LDHAL6B protein significantly increased at 10 days, decreased from 20 to 60 days, and then gradually elevated from 70 to 80 days after busulfan treatment.</p><p><strong>Conclusion: </strong>We revealed 190 significantly downregulated proteins in busulfan-treated mouse testes at 30 days and indicated that 70 days is the cut-off point of spermatogenic recovery for busulfan-treated mouse testis, increasing our understanding of this reproductive disorder model. An increased understanding of busulfan's toxic effect will help to prevent and treat reproductive diseases.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2442534"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Gastric Per-Oral Endoscopy Myotomy (G-POEM): Tips, Tricks, and Pitfalls. 胃经口腔内窥镜肌切开术(G-POEM):诀窍、技巧和陷阱。
Q1 Medicine Pub Date : 2025-12-01 Epub Date: 2024-11-06 DOI: 10.1007/s11894-024-00952-6
Grace E Kim, Mahnoor Khan, Sunil Amin, Amrita Sethi

Purpose of review: The number of hospitalizations for gastroparesis has risen over 300% in recent decades with increased physical, psychological, and healthcare burdens. Gastric per-oral endoscopic myotomy (G-POEM) is a promising therapy for patients with refractory gastroparesis. This article reviews important considerations for G-POEM.

Recent findings: Predictive factors for clinical success after G-POEM include diabetic and idiopathic gastroparesis, shorter gastroparesis duration, symptoms predominant of nausea and emesis, and gastric emptying study showing gastric retention of > 20% at 4 h. Mucosal closure is a critical step for G-POEM; both sutures and clips have high success rates, with clips having a trend to lower success rates but with significantly shorter procedure time and cheaper cost. G-POEMs have an overall 61% pooled success rate at one year with a yearly 13% symptom recurrence rate. A careful patient selection can yield higher clinical success rates. Further studies are needed on variant G-POEM techniques for more durable outcomes.

审查目的:近几十年来,因胃瘫住院的人数增加了 300% 以上,身体、心理和医疗负担也随之加重。胃经口内镜肌切开术(G-POEM)是一种治疗难治性胃瘫患者的有效方法。本文回顾了 G-POEM 的重要注意事项:G-POEM临床成功的预测因素包括糖尿病和特发性胃瘫、较短的胃瘫持续时间、以恶心和呕吐为主的症状,以及胃排空研究显示4小时内胃潴留>20%。粘膜闭合是G-POEM的关键步骤;缝合和夹子的成功率都很高,夹子的成功率有降低的趋势,但手术时间明显缩短,费用也更低。G-POEM 一年的总成功率为 61%,每年的症状复发率为 13%。谨慎选择患者可获得更高的临床成功率。还需要进一步研究变异的 G-POEM 技术,以获得更持久的疗效。
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引用次数: 0
Esophageal ESD Training; Perspective of West vs. East.
Q1 Medicine Pub Date : 2025-12-01 Epub Date: 2024-11-30 DOI: 10.1007/s11894-024-00951-7
Abdulrahman Qatomah, Hiroyuki Aihara

PURPOSE OF REVIEW: Esophageal cancer is one of the most common cancers in the world and carries a poor prognosis. While esophagectomy poses considerable mortality and morbidity risks, endoscopic resection can provide a safer and less invasive alternative. RECENT FINDINGS: Endoscopic resection therapy has allowed a less invasive approach with comparable outcomes to esophagectomy. EMR is considered safe and requires less intensive training, yet it does not offer complete histopathological assessment due to the nature of piecemeal resection for larger lesions. Alternatively, ESD offers an R0 resection, therefore allowing precise histopathological evaluation. Training in ESD is essential; however, a uniform training model has not been agreed upon. The Japanese apprenticeship training model has proven effective, with promising training outcomes from the Eastern experience. In the West, a comprehensive training model through a combination of apprenticeship with progressive exposure, including ex-vivo and live animal hands-on training, could be the optimal approach. Different methods of ESD training are currently available, all of which aim to provide the experience needed to perform safe ESD. Despite the differences in training styles between the East and the West, a modified apprenticeship model could potentially result in more effective and better training outcomes. The currently available technologies provide the environment to enhance ESD training.

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引用次数: 0
L3-SMI as a predictor of overall survival in oesophageal cancer patients receiving PD-1 inhibitors combined with chemotherapy.
Pub Date : 2025-12-01 Epub Date: 2024-12-12 DOI: 10.1080/07853890.2024.2440114
Huiya Ying, Yuhao Chen, Yiwen Hong, Kanglei Ying, Shiyu Li, Yuxuan Zhang, Tianhao Mei, Xian Song, Yuanhang He, Chenrui Yao, Fujun Yu

Background: Programmed death ligand-1 (PD-1), as an immunotherapy target, has been increasingly used in tumour therapies. But as reactions and outcomes to PD-1 inhibitors combined with chemotherapy vary individually, it is primarily important to identify an ideal indicator for predicting the therapeutic effectiveness in individual patients. Oesophageal cancer (EC) patients often have difficulty eating due to tumour blockage of the oesophagus, leading to malnutrition and muscle loss. Sarcopenia is one of the influencing factors for poor prognosis in tumour patients, but its role in PD-1 inhibitors combined with chemotherapy of EC patients is not fully clarified. In this study, we aimed to explore the prognostic significance of Sarcopenia measured by CT in EC patients treated with PD-1 antibody combined with chemotherapy.

Methods: The third lumbar skeletal muscle mass index (L3-SMI) was obtained from 83 EC patients before and 3 months after administration of PD-1 inhibitors combined with chemotherapy using conventional CT scans.

Results: Baseline L3-SMI and 3-month L3-SMI values were found not suitable for predicting the overall survival (OS) of EC patients (p = 0.32 & p = 0.055). Longitudinal change in L3-SMI (ΔL3-SMI) during PD-1 inhibitors combined with chemotherapy was identified as a relevant marker of OS in univariable analysis (HR: 0.98, 95% CI: 0.96-1.00, p = 0.042) and multivariable analysis (HR: 0.96, 95% CI: 0.93-0.99, p = 0.02). L3-SMI-positive patients generally had better OS (p = 0.041).

Conclusion: Excessive muscle loss rather than muscle loss before and after administration of PD-1 inhibitors combined with chemotherapy is an important prognostic factor for therapeutic outcomes and OS in EC patients.

{"title":"L3-SMI as a predictor of overall survival in oesophageal cancer patients receiving PD-1 inhibitors combined with chemotherapy.","authors":"Huiya Ying, Yuhao Chen, Yiwen Hong, Kanglei Ying, Shiyu Li, Yuxuan Zhang, Tianhao Mei, Xian Song, Yuanhang He, Chenrui Yao, Fujun Yu","doi":"10.1080/07853890.2024.2440114","DOIUrl":"10.1080/07853890.2024.2440114","url":null,"abstract":"<p><strong>Background: </strong>Programmed death ligand-1 (PD-1), as an immunotherapy target, has been increasingly used in tumour therapies. But as reactions and outcomes to PD-1 inhibitors combined with chemotherapy vary individually, it is primarily important to identify an ideal indicator for predicting the therapeutic effectiveness in individual patients. Oesophageal cancer (EC) patients often have difficulty eating due to tumour blockage of the oesophagus, leading to malnutrition and muscle loss. Sarcopenia is one of the influencing factors for poor prognosis in tumour patients, but its role in PD-1 inhibitors combined with chemotherapy of EC patients is not fully clarified. In this study, we aimed to explore the prognostic significance of Sarcopenia measured by CT in EC patients treated with PD-1 antibody combined with chemotherapy.</p><p><strong>Methods: </strong>The third lumbar skeletal muscle mass index (L3-SMI) was obtained from 83 EC patients before and 3 months after administration of PD-1 inhibitors combined with chemotherapy using conventional CT scans.</p><p><strong>Results: </strong>Baseline L3-SMI and 3-month L3-SMI values were found not suitable for predicting the overall survival (OS) of EC patients (<i>p</i> = 0.32 & <i>p</i> = 0.055). Longitudinal change in L3-SMI (ΔL3-SMI) during PD-1 inhibitors combined with chemotherapy was identified as a relevant marker of OS in univariable analysis (HR: 0.98, 95% CI: 0.96-1.00, <i>p</i> = 0.042) and multivariable analysis (HR: 0.96, 95% CI: 0.93-0.99, <i>p</i> = 0.02). L3-SMI-positive patients generally had better OS (<i>p</i> = 0.041).</p><p><strong>Conclusion: </strong>Excessive muscle loss rather than muscle loss before and after administration of PD-1 inhibitors combined with chemotherapy is an important prognostic factor for therapeutic outcomes and OS in EC patients.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2440114"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Structural or functional abnormality of sphincter of Oddi: an important factor for the recurrence of choledocholithiasis after endoscopic treatment.
Pub Date : 2025-12-01 Epub Date: 2024-12-13 DOI: 10.1080/07853890.2024.2440119
Ye Yang, Zeying Zhao, Shuodong Wu, Dianbo Yao

A high recurrence rate is undesirable after treatment of common bile duct (CBD) stones. A major risk factor identified for recurrence is that invasive techniques, including surgical or endoscopic treatments, will impair the biliary tract system either by direct incision of the CBD or by cutting or dilating the ampulla of Vater. During endoscopic treatment, two main assisted methods for lithotomy, sphincterotomy and papillary balloon dilation, can result in different degrees of damage to the structure and function of the sphincter of Oddi (SO), contributing to slowing of biliary excretion, cholestasis, biliary bacterial infection, and promotion of bile duct stone recurrence. In this review, the relationship between endoscopic lithotomy and structural impairment or functional abnormality of the SO will be summarized, and their relationship with the recurrence of CBD stones will also be analyzed. Further improvement of these endoscopic methods or exploration of some novel methods, such as endoscopic endoclip papilloplasty, temporary insertion of a self-expandable metal stent, and combined application of peroral cholangioscopy, may aid in providing more appropriate treatment for patients with choledocholithiasis, repair or protect the function and structure of SO, reduce or prevent the recurrence of bile duct stones, and improve patient outcomes.

总胆管(CBD)结石治疗后复发率高是不可取的。复发的一个主要风险因素是侵入性技术,包括外科手术或内窥镜治疗,会通过直接切开胆总管或切开或扩张瓦特氏瓿而损伤胆道系统。在内镜治疗过程中,括约肌切开术和乳头球囊扩张术这两种主要的辅助碎石方法会对奥奇氏括约肌(SO)的结构和功能造成不同程度的损伤,导致胆汁排泄减慢、胆汁淤积、胆道细菌感染和促进胆管结石复发。在这篇综述中,将总结内镜碎石术与奥狄氏括约肌结构损伤或功能异常之间的关系,并分析它们与胆总管结石复发的关系。进一步改进这些内镜方法或探索一些新的方法,如内镜下内夹乳头成形术、临时插入可自行扩张的金属支架、联合应用口周胆道镜等,可能有助于为胆总管结石患者提供更合适的治疗,修复或保护SO的功能和结构,减少或预防胆总管结石的复发,改善患者的预后。
{"title":"Structural or functional abnormality of sphincter of Oddi: an important factor for the recurrence of choledocholithiasis after endoscopic treatment.","authors":"Ye Yang, Zeying Zhao, Shuodong Wu, Dianbo Yao","doi":"10.1080/07853890.2024.2440119","DOIUrl":"https://doi.org/10.1080/07853890.2024.2440119","url":null,"abstract":"<p><p>A high recurrence rate is undesirable after treatment of common bile duct (CBD) stones. A major risk factor identified for recurrence is that invasive techniques, including surgical or endoscopic treatments, will impair the biliary tract system either by direct incision of the CBD or by cutting or dilating the ampulla of Vater. During endoscopic treatment, two main assisted methods for lithotomy, sphincterotomy and papillary balloon dilation, can result in different degrees of damage to the structure and function of the sphincter of Oddi (SO), contributing to slowing of biliary excretion, cholestasis, biliary bacterial infection, and promotion of bile duct stone recurrence. In this review, the relationship between endoscopic lithotomy and structural impairment or functional abnormality of the SO will be summarized, and their relationship with the recurrence of CBD stones will also be analyzed. Further improvement of these endoscopic methods or exploration of some novel methods, such as endoscopic endoclip papilloplasty, temporary insertion of a self-expandable metal stent, and combined application of peroral cholangioscopy, may aid in providing more appropriate treatment for patients with choledocholithiasis, repair or protect the function and structure of SO, reduce or prevent the recurrence of bile duct stones, and improve patient outcomes.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2440119"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Characteristics, outcomes and the necessity of continued guideline-directed medical therapy in patients with heart failure with improved ejection fraction.
Pub Date : 2025-12-01 Epub Date: 2024-12-17 DOI: 10.1080/07853890.2024.2442535
Qin-Fen Chen, Yindan Lu, Christos S Katsouras, Yangdi Peng, Junfang Sun, Mingming Li, Chenyang Liu, Hongxia Yao, Liyou Lian, Xiaofang Feng, Wei-Hong Lin, Xiao-Dong Zhou

Background: Much remains to be learned about patients with heart failure with improved ejection fraction (HFimpEF).

Objective: This study sheds light on the characteristics and clinical outcomes of HFimpEF patients, including the consequences of halting guideline-directed medical therapy (GDMT).

Methods: This retrospective study was conducted on patients diagnosed with heart failure with reduced ejection fraction (HFrEF) who underwent a second echocardiogram at least 6 months apart between January 2009 and February 2023. The primary outcomes were major adverse cardiovascular events (MACEs), including all-cause mortality and heart failure hospitalization. The second outcome was recurrent HFrEF.

Results: Of 4,560 HFrEF patients were included, 3,289 (72.1%) achieved HFimpEF within a median follow-up period of 3.4 years (IQR: 1.8 - 5.9 years). Among these HFimpEF patients, recurrent HFrEF was observed in 941 (28.6%) patients during a median follow-up period of 2.3 years (IQR: 0.8-4.6 years). The proportion of patients who halted GDMT was 70.4%, 53.2%, 59.8% and 63.8% for MRA, beta-blockers, ACEI/ARB/ARNI and SGLT-2 inhibitors. Multivariable Cox analysis revealed ischemic heart disease, chronic kidney disease, coronary heart disease, lower left ventricular ejection fraction, larger left ventricular diastolic dimension and non-use GDMT are associated with recurrent HFrEF. Individuals without GDMT use exhibited lower chances of persistently recovering ejection fraction and high risks of MACEs compared to those who continue use.

Conclusions: HFimpEF is a common condition across all clinical follow-ups. Prevalent discontinuation of GDMT medications may contribute significantly to recurrent HFrEF, placing patients at a higher risk for poor prognosis.

{"title":"Characteristics, outcomes and the necessity of continued guideline-directed medical therapy in patients with heart failure with improved ejection fraction.","authors":"Qin-Fen Chen, Yindan Lu, Christos S Katsouras, Yangdi Peng, Junfang Sun, Mingming Li, Chenyang Liu, Hongxia Yao, Liyou Lian, Xiaofang Feng, Wei-Hong Lin, Xiao-Dong Zhou","doi":"10.1080/07853890.2024.2442535","DOIUrl":"https://doi.org/10.1080/07853890.2024.2442535","url":null,"abstract":"<p><strong>Background: </strong>Much remains to be learned about patients with heart failure with improved ejection fraction (HFimpEF).</p><p><strong>Objective: </strong>This study sheds light on the characteristics and clinical outcomes of HFimpEF patients, including the consequences of halting guideline-directed medical therapy (GDMT).</p><p><strong>Methods: </strong>This retrospective study was conducted on patients diagnosed with heart failure with reduced ejection fraction (HFrEF) who underwent a second echocardiogram at least 6 months apart between January 2009 and February 2023. The primary outcomes were major adverse cardiovascular events (MACEs), including all-cause mortality and heart failure hospitalization. The second outcome was recurrent HFrEF.</p><p><strong>Results: </strong>Of 4,560 HFrEF patients were included, 3,289 (72.1%) achieved HFimpEF within a median follow-up period of 3.4 years (IQR: 1.8 - 5.9 years). Among these HFimpEF patients, recurrent HFrEF was observed in 941 (28.6%) patients during a median follow-up period of 2.3 years (IQR: 0.8-4.6 years). The proportion of patients who halted GDMT was 70.4%, 53.2%, 59.8% and 63.8% for MRA, beta-blockers, ACEI/ARB/ARNI and SGLT-2 inhibitors. Multivariable Cox analysis revealed ischemic heart disease, chronic kidney disease, coronary heart disease, lower left ventricular ejection fraction, larger left ventricular diastolic dimension and non-use GDMT are associated with recurrent HFrEF. Individuals without GDMT use exhibited lower chances of persistently recovering ejection fraction and high risks of MACEs compared to those who continue use.</p><p><strong>Conclusions: </strong>HFimpEF is a common condition across all clinical follow-ups. Prevalent discontinuation of GDMT medications may contribute significantly to recurrent HFrEF, placing patients at a higher risk for poor prognosis.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2442535"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Current Landscape of Endoscopic Submucosal Training in the United States. 美国内镜粘膜下培训的现状。
Q1 Medicine Pub Date : 2025-12-01 Epub Date: 2024-11-07 DOI: 10.1007/s11894-024-00950-8
Mike T Wei, Shai Friedland, Joo Ha Hwang

Purpose of review: Endoscopic submucosal dissection (ESD) has been found to increase en bloc and R0 resection as well as decrease risk of recurrence. However, despite literature supporting the benefits of endoscopic submucosal dissection, adoption of ESD in the United States has been challenging, driven by factors including requirement for specialized training as well as limitations in training availability.

Recent findings: Many devices have been developed to improve ease and therefore adoption for the procedure, with advancements in stability, resection as well as closure of the mucosal defect following resection. While the Japanese model of training in ESD centers around the Master-Apprentice model, this is scarce in the United States. Most US endoscopists therefore must follow other paths to learn and become proficient at ESD. There has been a rapid expansion in literature on ESD, fellowship programs, opportunities for case observation, and significant evolution in ex vivo training models that can assist an endoscopist in receiving training in ESD. Currently, there are three main ways of learning to perform ESD in the United States: 1. Third space endoscopy fellowship; 2. Master-apprentice model; 3. Utilization of live courses and proctored procedures. ESD is the optimal method to ensure en bloc resection of large mucosal neoplasms of the gastrointestinal tract. While several barriers hinder adoption of ESD in the United States, there has been significant development both in procedural and training aspects. Further research and discussions are needed to determine criteria for credentialing and proficiency in ESD.

审查目的:研究发现,内镜下粘膜下剥离术(ESD)可提高全切率和R0切除率,并降低复发风险。然而,尽管有文献支持内镜粘膜下剥离术的益处,但在美国,ESD的应用一直面临挑战,其原因包括需要专业培训以及培训可用性的限制:最近的研究结果:已开发出许多设备来提高手术的简便性,从而提高手术的采用率,并在稳定性、切除以及切除后粘膜缺损的闭合方面取得了进步。日本的 ESD 培训模式以师徒模式为中心,但在美国却很少有这种模式。因此,大多数美国内镜医师必须通过其他途径学习并熟练掌握 ESD。有关 ESD 的文献、奖学金计划、病例观察机会以及可帮助内镜医师接受 ESD 培训的体外培训模式都在迅速发展。目前,美国有三种主要的ESD学习方法:1.第三空间内窥镜奖学金;2.师徒模式;3.利用现场课程和监考程序。ESD是确保胃肠道大型粘膜肿瘤全切的最佳方法。虽然在美国采用 ESD 存在一些障碍,但在程序和培训方面都有了长足的发展。需要进一步研究和讨论,以确定ESD的认证和熟练标准。
{"title":"The Current Landscape of Endoscopic Submucosal Training in the United States.","authors":"Mike T Wei, Shai Friedland, Joo Ha Hwang","doi":"10.1007/s11894-024-00950-8","DOIUrl":"https://doi.org/10.1007/s11894-024-00950-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Endoscopic submucosal dissection (ESD) has been found to increase en bloc and R0 resection as well as decrease risk of recurrence. However, despite literature supporting the benefits of endoscopic submucosal dissection, adoption of ESD in the United States has been challenging, driven by factors including requirement for specialized training as well as limitations in training availability.</p><p><strong>Recent findings: </strong>Many devices have been developed to improve ease and therefore adoption for the procedure, with advancements in stability, resection as well as closure of the mucosal defect following resection. While the Japanese model of training in ESD centers around the Master-Apprentice model, this is scarce in the United States. Most US endoscopists therefore must follow other paths to learn and become proficient at ESD. There has been a rapid expansion in literature on ESD, fellowship programs, opportunities for case observation, and significant evolution in ex vivo training models that can assist an endoscopist in receiving training in ESD. Currently, there are three main ways of learning to perform ESD in the United States: 1. Third space endoscopy fellowship; 2. Master-apprentice model; 3. Utilization of live courses and proctored procedures. ESD is the optimal method to ensure en bloc resection of large mucosal neoplasms of the gastrointestinal tract. While several barriers hinder adoption of ESD in the United States, there has been significant development both in procedural and training aspects. Further research and discussions are needed to determine criteria for credentialing and proficiency in ESD.</p>","PeriodicalId":10776,"journal":{"name":"Current Gastroenterology Reports","volume":"27 1","pages":"1-9"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Validation of salivary proteomic biomarkers for early detection of oral cancer in the Egyptian population.
IF 2.4 Q3 MEDICINE, RESEARCH & EXPERIMENTAL Pub Date : 2025-12-01 Epub Date: 2024-12-06 DOI: 10.1080/20565623.2024.2432222
Dalia Ghalwash, Ahmed Ammar, Asmaa Abou-Bakr, Al-Hassan Diab, Ayman El-Gawish

Purpose: The present study evaluated the sensitivity and specificity of important proteomic salivary biomarkers; IL-6, IL-8, and sCD44 in the early detection of oral cancer, and any possible associations with risk factors of oral cancer in an Egyptian population.

Methods: The present investigation was conducted on 100 individuals; 25 healthy controls, 25 patients having oral potentially malignant disorders (OPMDs) with dysplasia; 25 patients having OPMDs without dysplasia, and 25 oral cancer patients. Demographic data modified gingival index, oral hygiene level, and salivary levels of the biomarkers were assessed.

Results: Salivary levels of IL-6, IL-8, and sCD44 progressively increased with increased disease severity. Salivary IL-8 and IL-6 levels possess a discriminating potential from normal tissue through different degrees of dysplasia to oral cancer, sCD44 levels had a discriminating power between normal and dysplastic tissues with high sensitivity and specificity. A positive correlation was found between the three biomarkers and the grade of oral squamous cell carcinoma (OSCC) and with different risk factors.

Conclusion: This is the first study that evaluated multiple salivary proteomic biomarkers in the Egyptian population, and the results validate the ability of IL-6, IL-8, and sCD44 to be used as sensitive diagnostic and prognostic biomarkers for screening and early detection of oral cancer.

{"title":"Validation of salivary proteomic biomarkers for early detection of oral cancer in the Egyptian population.","authors":"Dalia Ghalwash, Ahmed Ammar, Asmaa Abou-Bakr, Al-Hassan Diab, Ayman El-Gawish","doi":"10.1080/20565623.2024.2432222","DOIUrl":"10.1080/20565623.2024.2432222","url":null,"abstract":"<p><strong>Purpose: </strong>The present study evaluated the sensitivity and specificity of important proteomic salivary biomarkers; IL-6, IL-8, and sCD44 in the early detection of oral cancer, and any possible associations with risk factors of oral cancer in an Egyptian population.</p><p><strong>Methods: </strong>The present investigation was conducted on 100 individuals; 25 healthy controls, 25 patients having oral potentially malignant disorders (OPMDs) with dysplasia; 25 patients having OPMDs without dysplasia, and 25 oral cancer patients. Demographic data modified gingival index, oral hygiene level, and salivary levels of the biomarkers were assessed.</p><p><strong>Results: </strong>Salivary levels of IL-6, IL-8, and sCD44 progressively increased with increased disease severity. Salivary IL-8 and IL-6 levels possess a discriminating potential from normal tissue through different degrees of dysplasia to oral cancer, sCD44 levels had a discriminating power between normal and dysplastic tissues with high sensitivity and specificity. A positive correlation was found between the three biomarkers and the grade of oral squamous cell carcinoma (OSCC) and with different risk factors.</p><p><strong>Conclusion: </strong>This is the first study that evaluated multiple salivary proteomic biomarkers in the Egyptian population, and the results validate the ability of IL-6, IL-8, and sCD44 to be used as sensitive diagnostic and prognostic biomarkers for screening and early detection of oral cancer.</p>","PeriodicalId":12568,"journal":{"name":"Future Science OA","volume":"11 1","pages":"2432222"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prenatal genetic detection in foetus with gallbladder size anomalies: cohort study and systematic review of the literature.
Pub Date : 2025-12-01 Epub Date: 2024-12-13 DOI: 10.1080/07853890.2024.2440638
Yimo Zeng, Rong Hu, Jian Lu, Yiming Qi, Dan Chen, Chaoxiang Yang, Jing Wu

Objectives: The aim of the study was to evaluate the detection rate of genetic abnormalities in cases of foetal gallbladder (FGB) size abnormalities to determine whether these abnormalities justify prenatal diagnosis.

Methods: Two hundred and twenty-seven foetuses with gallbladder (GB) size anomalies who underwent prenatal diagnosis between January 2015 and June 2024 were included in the study. All these patients underwent chromosomal microarray and/or karyotyping, and 37 cases also underwent whole exome sequencing (WES). Two hundred and eight cases were followed up for postnatal outcomes. Then, we reviewed the literature of FGB anomalies cases with confirmed chromosomal results.

Results: The study included 227 foetuses, comprising 60 cases with isolated GB size anomalies and 167 cases with non-isolated GB size anomalies. Non-isolated GB size anomalies were associated with findings such as hyperechogenic bowel, ventriculomegaly, foetal growth restriction (FGR), cardiac anomalies, renal dysplasia and single umbilical artery. The overall diagnostic yield of genetic tests was 10.57% (24/227). Aneuploidies were identified in seven foetuses. Pathogenic/likely pathogenic copy number variations (CNVs) were found in nine foetuses, and α0-thalassemia in five foetuses. Additionally, three pathogenic single-nucleotide variants (SNVs) were detected through WES. Foetuses with non-isolated GB size anomalies showed a higher rate of detecting genetic abnormalities compared to those with isolated GB size anomalies, with a significant difference in statistical analysis (13.2% vs. 3.3%, p = .033, Chi-square test). A total of eight studies, involving 407 cases met the criteria for inclusion in the systematic review. Overall, 28 foetuses were identified to have chromosomal abnormalities (6.9%, 28/407).

Conclusions: This study indicates that parents of foetuses with GB size anomalies should be informed about the potential for aneuploidy, pathogenic CNVs and SNVs, and genetic testing should be recommended in cases of non-isolated foetal GB size anomalies.

{"title":"Prenatal genetic detection in foetus with gallbladder size anomalies: cohort study and systematic review of the literature.","authors":"Yimo Zeng, Rong Hu, Jian Lu, Yiming Qi, Dan Chen, Chaoxiang Yang, Jing Wu","doi":"10.1080/07853890.2024.2440638","DOIUrl":"https://doi.org/10.1080/07853890.2024.2440638","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of the study was to evaluate the detection rate of genetic abnormalities in cases of foetal gallbladder (FGB) size abnormalities to determine whether these abnormalities justify prenatal diagnosis.</p><p><strong>Methods: </strong>Two hundred and twenty-seven foetuses with gallbladder (GB) size anomalies who underwent prenatal diagnosis between January 2015 and June 2024 were included in the study. All these patients underwent chromosomal microarray and/or karyotyping, and 37 cases also underwent whole exome sequencing (WES). Two hundred and eight cases were followed up for postnatal outcomes. Then, we reviewed the literature of FGB anomalies cases with confirmed chromosomal results.</p><p><strong>Results: </strong>The study included 227 foetuses, comprising 60 cases with isolated GB size anomalies and 167 cases with non-isolated GB size anomalies. Non-isolated GB size anomalies were associated with findings such as hyperechogenic bowel, ventriculomegaly, foetal growth restriction (FGR), cardiac anomalies, renal dysplasia and single umbilical artery. The overall diagnostic yield of genetic tests was 10.57% (24/227). Aneuploidies were identified in seven foetuses. Pathogenic/likely pathogenic copy number variations (CNVs) were found in nine foetuses, and α0-thalassemia in five foetuses. Additionally, three pathogenic single-nucleotide variants (SNVs) were detected through WES. Foetuses with non-isolated GB size anomalies showed a higher rate of detecting genetic abnormalities compared to those with isolated GB size anomalies, with a significant difference in statistical analysis (13.2% vs. 3.3%, <i>p</i> = .033, Chi-square test). A total of eight studies, involving 407 cases met the criteria for inclusion in the systematic review. Overall, 28 foetuses were identified to have chromosomal abnormalities (6.9%, 28/407).</p><p><strong>Conclusions: </strong>This study indicates that parents of foetuses with GB size anomalies should be informed about the potential for aneuploidy, pathogenic CNVs and SNVs, and genetic testing should be recommended in cases of non-isolated foetal GB size anomalies.</p>","PeriodicalId":93874,"journal":{"name":"Annals of medicine","volume":"57 1","pages":"2440638"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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