Annals of Medicine and Surgery最新文献

Chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL) predominantly affect older adults, presenting unique challenges in early detection and long-term management. The growing elderly population globally has intensified the public health burden of these chronic leukemias, particularly in low-resource settings. This narrative review synthesizes current evidence on the epidemiology, clinical features, early detection, and long-term care of CML and CLL in elderly populations, with a focus on public health implications and region-specific considerations. A structured literature search was conducted across PubMed, Scopus, Web of Science, and Google Scholar, including studies published from 2000 to 2025. Risk-based screening protocols, economic burden, and disparities in low-resource settings were emphasized. CML and CLL incidence increases with age, with median diagnosis ages of 67 and 70 years, respectively. Early detection is often delayed due to non-specific symptoms, limited molecular diagnostics, and sociocultural factors. Long-term management is complicated by comorbidities, treatment adherence challenges, and fragmented care systems. Evidence-based strategies, including risk-based screening, multidisciplinary care, and community-based interventions, improve outcomes. In low-resource settings such as Zimbabwe, disparities in diagnostic capacity, drug availability, and supportive care significantly affect disease outcomes. Economic analyses highlight that early detection and guideline-adherent monitoring are cost-effective, reducing complications and optimizing resource utilization. Effective management of CML and CLL in elderly populations requires integrated strategies combining early detection, personalized care, and health system strengthening. Tailored interventions addressing both clinical and socioeconomic determinants of health, particularly in low-resource environments, are essential to improve survival, quality of life, and cost efficiency.

Introduction: Branchial cleft anomalies are congenital defects resulting from incomplete obliteration of branchial apparatus during embryogenesis. Second branchial cleft anomalies are the most common type, typically presenting as cysts or sinuses. Complete fistulae are rare, and bilateral complete second branchial cleft fistulae are exceedingly rare, with only a few cases reported in the literature to date.

Case presentation: We present a case of a 17-year-old female with bilateral mucopurulent neck discharge since birth, worsening in recent months. Clinical examination revealed two cutaneous openings along the anterior border of the sternocleidomastoid muscle. Fistulography demonstrated bilateral linear tracts extending toward the tonsillar fossae, consistent with complete second branchial cleft fistulae. Audiological and renal evaluations were normal, effectively ruling out branchio-oto-renal syndrome. The patient was referred to a specialized otorhinolaryngology center for surgical excision.

Discussion: This case highlights an exceptionally rare anomaly - bilateral complete second branchial cleft fistulae. The diagnosis can be easily missed or delayed due to its rarity and nonspecific presentation. Fistulography remains a reliable and cost-effective method for delineating the tract; meanwhile, MRI and contrast-enhanced CT provide excellent soft tissue detail and help identify the tract's relation to vital structures. Surgical excision is the definitive treatment, with the stepladder approach offering superior access and reduced recurrence in complex cases. Our case contributes valuable data to the limited literature and underscores the importance of considering bilateral anomalies in chronic or congenital neck discharges.

Conclusion: Timely recognition and management of rare branchial anomalies are crucial to prevent recurrent infections and complications.

Acute myeloid leukemia (AML) is a fast-progressing blood cancer marked by immature myeloid cells and poor survival rates. Most AML subtypes resist standard treatments, especially in older adults, highlighting the need for new targeted therapies. A hallmark of AML is LSD1 overexpression, which blocks blood cell maturation. Though some LSD1 inhibitors can trigger differentiation, their use is limited by toxicity and incomplete target inhibition. PROTAC degraders like MS9117 offer a promising solution by eliminating LSD1. This halts leukemia growth, promotes robust cell differentiation, and restores sensitivity to agents like all-trans retinoic acid, benefits not seen with traditional inhibitors. PROTACs can also target previously undruggable proteins, such as transcription factors, potentially enabling lower doses and fewer side effects. Several PROTAC therapies are now in AML trials. LSD1-targeted degradation is promising, but further research is needed to confirm its safety, overcome resistance, and identify optimal drug combinations for AML treatment.

Background: Thiazide diuretics are commonly prescribed for the treatment of hypertension (HTN). However, the comparative efficacy and safety of hydrochlorothiazide (HCTZ) versus chlorthalidone (CTD) in managing patients with HTN remain unclear.

Materials and methods: A comprehensive literature search was performed using two electronic databases, MEDLINE and Cochrane, from their inception through November 2024. The aim was to identify randomized controlled trials or observational double-arm studies assessing the effects of HCTZ versus CTD on cardiovascular outcomes and safety in patients with HTN. Outcomes were reported as hazard ratios (HRs) with 95% confidence intervals (CIs), and analyses were conducted using a random effects model. A P-value of <0.05 was considered statistically significant.

Results: Of the 409 articles identified in the initial search, six relevant studies were included in the final analysis. No significant differences were observed between the HCTZ and CTD arms for cardiovascular outcomes, including major adverse cardiovascular events, myocardial infarction, stroke, hospitalization for heart failure, and angina. However, patients receiving CTD experienced significantly higher rates of hypokalemia and hyponatremia compared to those on HCTZ. The risk of acute kidney injury did not differ significantly between the two groups.

Conclusion: HCTZ and CTD showed comparable efficacy in terms of cardiovascular outcomes. Nevertheless, HCTZ appeared to have a safer profile, with a lower incidence of electrolyte imbalances, such as hypokalemia and hyponatremia, compared to CTD.

Augmented reality (AR) is transforming cancer surgery by combining medical imaging with real-time visualization during operations. Using 3D digital models of tumors, AR allows surgeons to see the precise location and borders of cancers directly on the patient. Early studies in breast, brain, urologic, and skin cancers show that AR improves accuracy and helps surgeons remove tumors more completely and safely. Research from China and South Korea has demonstrated accurate margin identification in skin and breast tumor surgeries, while teams in Italy and Belgium have reported better surgical planning and shorter operation times in prostate and brain tumor procedures. AR is also being used to train surgeons in low-resource settings, improving access to advanced surgical methods worldwide. Positive surgical margins, which are associated with increased local recurrence rates and reduced survival, highlight the critical need for accurate intraoperative tumor visualization across tumor types. Although more clinical trials are needed to confirm its ability to reduce positive margins, AR-guided tumor mapping shows great promise as a standard tool to support safer, more precise oncologic surgery.