Annals of Medicine and Surgery最新文献

Smoking cessation is a major public health goal, yet concerns about post-cessation weight gain remain a significant barrier for many smokers. The metabolic and behavioral changes following nicotine withdrawal frequently lead to increased caloric intake and reduced energy expenditure, potentially triggering relapse. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), originally developed for type 2 diabetes and later approved for weight management, have recently been investigated as a potential strategy to address both nicotine dependence and weight control. Emerging evidence from preclinical studies and limited clinical trials suggests that GLP-1 RAs may reduce nicotine cravings and intake by modulating central reward pathways while simultaneously curbing appetite and supporting weight loss. This dual mechanism may improve quit success rates and mitigate the psychological burden of post-cessation weight gain. However, the current human evidence base is limited, with small sample sizes, short follow-up periods, and reliance on preliminary data. While the pharmacological profile and cardiometabolic benefits of GLP-1 RAs make them a promising candidate for adjunctive use in smoking cessation, more rigorous randomized controlled trials are required to confirm efficacy, evaluate safety, and establish clinical guidelines. This narrative review synthesizes existing evidence to highlight both the potential and the current uncertainties surrounding GLP-1 RAs as dual-target pharmacotherapy for smoking cessation and weight management.

Introduction: One of the leading causes of cardiovascular death is hypertensive heart disease (HHD), especially in people who also have behavioral and mental disorders (BMDs). Cardiovascular risk is increased in this population by lifestyle factors, drug side effects, and inflammatory pathways. National data on HHD mortality trends for impacted subgroups in the USA are still scarce, despite the growing burden of both BMDs and HHD.

Methods: Using the CDC WONDER Multiple Cause of Death database, we examined death records from 1999 to 2020 in the USA. ICD-10 codes for BMDs (F01-F99) and hypertensive cardiac disease (I11.0-I11.9) were used to identify cases. Regional and demographic-specific age-adjusted mortality rates (AAMRs) were computed. Annual percent changes (APCs) and trends were assessed using joinpoint regression, with significance set at P < 0.05.

Results: About 284 797 people died from HHD with accompanying mental illnesses between 1999 and 2020. From 1.15 to 13.69 per 100 000, the AAMR increased (AAPC: 11.65%; P < 0.0001). AAMRs peaked among Black adults and were consistently higher in men. Regional load was largest in the South, and final fatality rates were higher in urban than rural areas. Disparities at the state level varied from 1.40 in Nebraska to 15.71 in Washington, DC. The greatest increases in HHD-related mortality were linked to male sex, substance-related mental illnesses, and living in underserved areas.

Conclusion: Men, Black adults, and Southern regions were disproportionately affected by the more than 10-fold increase in mortality from HHD and mental disorders between 1999 and 2020. Urban areas saw the largest increases, underscoring the urgent regional and demographic disparities that require focused interventions.

Introduction: Syphilis, caused by Treponema pallidum, the "great imitator," has re-emerged as a public health concern. It presents with diverse manifestations, ranging from asymptomatic meningitis and psychiatric changes to meningovascular syphilis presenting as ischemic stroke. We aim to report a case of an elderly male with cerebral neurosyphilis mimicking an acute frontal lobe infarction, emphasizing the importance of considering syphilis in patients with atypical risk factors or clinical presentations.

Case presentation: A 77-year-old male presented with subacute personality changes and executive dysfunction. Neuroimaging demonstrated nonspecific right frontal lobe changes without definitive evidence of acute ischemia. Serologic testing revealed a positive serum Venereal Disease Research Laboratory (VDRL) titer of 1:256, and cerebrospinal fluid (CSF) analysis confirmed neurosyphilis. The patient was treated with intravenous benzylpenicillin with clinical and serologic improvement.

Discussion: Cerebral neurosyphilis can mimic acute cerebral infarction, often leading to delayed diagnosis. This case underscores the importance of maintaining a broad differential diagnosis and emphasizes the value of obtaining a thorough social and sexual history, even in elderly patients. Early recognition of this treatable condition can prevent irreversible neurological sequelae.

Conclusion: Clinicians should maintain a high index of suspicion for neurosyphilis in elderly patients presenting with new-onset neuropsychiatric or ischemic symptoms. Careful investigation, including serologic testing for sexually transmitted infections, is essential for timely diagnosis and management.

Aim: This systematic review aimed to assess the clinical and radiographic success of vital pulp therapy in primary teeth using calcium-enriched mixture (CEM) compared to mineral trioxide aggregate (MTA).

Methods: Five electronic databases (PubMed, Scopus, EBSCO, Cochrane, and Web of Science) were searched for randomized controlled trials (RCTs) comparing the success rates of CEM and MTA as pulp dressing materials in primary teeth. The search strategy included terms related to CEM, vital pulp therapy, and primary teeth. The quality of the included studies was assessed using the revised risk of bias tool for randomized trials (RoB 2).

Results: The search yielded 1834 publications, of which three RCTs met the inclusion criteria. These studies, published between 2011 and 2016, included a total of 108 children aged 4-8 years. All included studies were judged to raise some concerns regarding the risk of bias.

Conclusions: Based on the limited available evidence, CEM may be considered a potential alternative to MTA for vital pulp therapy in primary teeth, with similar clinical and radiographic success rates. However, due to concerns about study quality and small sample sizes, further well-designed randomized clinical trials are necessary to draw more definitive conclusions.

Background: Intraoperative neuromonitoring (IONM) is an emerging alternative to visual identification of the recurrent laryngeal nerve (RLN) during surgery. Its goal is to reduce RLN injury and vocal cord paralysis (VCP). However, evidence has been inconsistent concerning its benefits. This study aims to assess IONM's efficacy in preventing RLN injury during robotic thyroidectomy (RoT).

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted across four electronic databases: PubMed, Web of Science, EMBASE, and Cochrane Library. The inclusion criteria comprised studies published in English that focused on RoT procedures utilizing IONM to assess their effect on RLN injury. Exclusion criteria included non-English publications, studies without full-text availability, reviews, editorials, case reports, animal studies, and studies that did not meet our objectives. After screening, data were extracted and presented qualitatively.

Results: An analysis of six studies involving 1006 patients, where the majority evaluated IONM within RoT procedures. Continuous IONM (C-IONM) was feasible and effective for identifying RLN and aiding in its preservation. Outcomes such as success rates, electromyography signal quality, VCP incidence, hypoparathyroidism, hypocalcemia, and bleeding showed comparable trends across groups. Notably, a study found that RoT using IONM, particularly C-IONM, was associated with significantly longer operative times averaging approximately 55.8 minutes longer than open thyroidectomy. Despite this, findings emphasized the protective role of C-IONM in minimizing nerve injury during robotic thyroid procedures, although it did not significantly impact postoperative complications like VCP or length of stay.

Conclusion: Our findings suggest that IONM, particularly C-IONM, is feasible during RoT and may support RLN identification and preservation. However, current evidence is limited, and further well-designed studies are needed to clarify its clinical impact and establish criteria for routine use.

Ophthalmic diseases such as diabetic retinopathy, glaucoma, age-related macular degeneration, and inherited retinal dystrophies remain leading causes of visual impairment worldwide, necessitating accurate diagnosis and longitudinal monitoring. Modern ophthalmology increasingly relies on facial and ocular imaging, yet the integration of artificial intelligence (AI) into these workflows raises significant privacy concerns. ROFI (Reversible Ophthalmic Face Image anonymizer) is a novel deep learning-based framework designed to anonymize patient facial features while preserving ophthalmic signs essential for diagnosis. By employing weakly supervised learning and neural identity translation, ROFI achieves high accuracy in retaining ocular disease markers while ensuring reversibility for authorized clinical review. Comparative studies demonstrate that anonymized images maintain diagnostic fidelity for retinal disease classification, while AI-based intraoperative guidance systems further enhance surgical precision and patient safety. Despite these advances, challenges remain regarding dataset diversity, external validation, bias, and cost-effectiveness, particularly in resource-limited settings. Future strategies should emphasize multicenter validation, integration into electronic health records, and awareness campaigns to promote adoption. ROFI represents a significant step toward balancing patient privacy with diagnostic accuracy, offering a scalable solution for secure, AI-driven ophthalmic care.