Clinical implications

临床意义
  • 文章类型: Journal Article
    The BRAFV600E mutation has been extensively studied in various cancers, but its role in breast lesions remains less understood. Immunohistochemistry (IHC) has emerged as a valuable tool for detecting BRAFV600E expression in breast tissue, aiding in diagnosis and prognosis. This comprehensive review examines the significance of BRAFV600E IHC in breast lesions, encompassing its frequency, association with clinicopathological features, and potential clinical implications. We summarize key findings, emphasizing their utility in diagnosis, prognosis prediction, and treatment response assessment. Additionally, we discuss implications for clinical practice, highlighting the need for integrating BRAFV600E IHC into diagnostic algorithms. Recommendations for future research include larger-scale studies to validate findings, optimize detection techniques, and explore therapeutic interventions targeting BRAFV600E in breast cancer. This review contributes to understanding the molecular landscape of breast lesions and informs clinical decision-making in their management.
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  • 文章类型: Journal Article
    背景:在过去的二十年中,社交媒体在神经外科领域的使用非常激烈。近70%的神经外科医生使用Facebook等社交媒体平台。X(以前的Twitter),YouTube,和Instagram用于专业发展。这篇文献综述旨在量化社交媒体在神经外科领域的使用,它的好处,和影响。
    方法:通过搜索PubMed,科学直接,和谷歌学者关于社交媒体和神经外科的文章。搜索策略中使用的网格术语包括“社交媒体”,“神经外科”,\"教育\"\"福利\",“后果”和相关变体。纳入标准涉及研究方法,包括gobservational研究,病例报告和全面审查,并调查了社交媒体对神经外科医生的益处和局限性的各个方面,包括它在社区建设中的重要性,专业发展,对研究和出版物的贡献,导师,文化多样性和其他相关利益。
    结果:搜索结果为635articles,根据相关性筛选了437篇独特的文章。经过细致的筛选,86篇文章进行了全文评估,结果纳入了符合资格标准的22篇文章。洞察力来自社交媒体的好处,它目前的局限性在于围绕神经外科使用社交媒体的趋势和人口统计。
    结论:在当今现代化的世界中,社交媒体在神经外科方面是一把双刃剑;它提供了无与伦比的合作机会,教育,患者参与,和支持,同时要求谨慎使用和导航,以减轻与之相关的风险。
    BACKGROUND: The use of social media has been drastic in the field of neurosurgery over the last two decades. Almost 70 % of neurosurgeons use social media platforms such as Facebook, X (formerly Twitter), YouTube, and Instagram for purposes of professional growth. This literature review aims to quantify the use of social media in the field of neurosurgery, its benefits, and implications.
    METHODS: A systematic review was conducted by searching PubMed, Science Direct, and Google Scholar for articles pertaining tosocial media and neurosurgery.Mesh terms employed in the search strategy encompassed \"Social Media\", \"neurosurgery\", \"education\"\"benefits\", \"consequences\"and related variations.Inclusion criteria involved studiesvaryingin methodology, includingobservational studies, case reports and comprehensive reviewsand investigatingvarious aspects of benefits and limitations of social media for neurosurgeons, encompassing its importance in community building, professional development, contribution to research and publications, mentorship, cultural diversity and other pertinent benefits.
    RESULTS: The search yielded635articles, with437unique articles screened based on relevance. Following a meticulous screening process,86articles underwent full-text assessment, resulting in the inclusion of22articles meeting the eligibility criteria.Insights were derived onthebenefits of social media,its current limitationsas well astrends and demographics surrounding social media use in neurosurgery.
    CONCLUSIONS: In todays modernized world, social media acts as a double-edged sword when it comes to neurosurgery; it offers unparalleled opportunities for collaboration, education, patient engagement, and support while demanding careful use and navigation to mitigate the risks associated with it.
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  • 文章类型: Journal Article
    受体酪氨酸激酶(RTK)是具有激酶活性的细胞表面受体,在多种细胞过程中起着至关重要的作用。在RTK家族成员中,人表皮生长因子受体2(HER2)和HER3与乳腺癌特别相关。这篇综述深入研究了受体酪氨酸激酶相互作用的复杂性,抵抗机制,以及抗HER3药物的潜力,为这一研究领域的临床意义和未来方向提供有价值的见解。它评估了抗HER3药物的潜力,如帕妥珠单抗,克服在HER2阳性乳腺癌治疗中观察到的耐药性。该综述还探讨了与各种药物相关的耐药机制,包括曲妥珠单抗,拉帕替尼,和PI3K抑制剂,提供有关抗性发展的复杂分子过程的见解。该综述最后强调了进一步临床试验的必要性,以评估HER3抑制剂的疗效,以及开发安全有效的抗HER3治疗以改善HER2阳性乳腺癌患者治疗结果的潜力。
    Receptor tyrosine kinases (RTKs) are cell surface receptors with kinase activity that play a crucial role in diverse cellular processes. Among the RTK family members, Human epidermal growth factor receptor 2 (HER2) and HER3 are particularly relevant to breast cancer. The review delves into the complexities of receptor tyrosine kinase interactions, resistance mechanisms, and the potential of anti-HER3 drugs, offering valuable insights into the clinical implications and future directions in this field of study. It assesses the potential of anti-HER3 drugs, such as pertuzumab, in overcoming resistance observed in HER2-positive breast cancer therapies. The review also explores the resistance mechanisms associated with various drugs, including trastuzumab, lapatinib, and PI3K inhibitors, providing insights into the intricate molecular processes underlying resistance development. The review concludes by emphasizing the necessity for further clinical trials to assess the efficacy of HER3 inhibitors and the potential of developing safe and effective anti-HER3 treatments to improve treatment outcomes for patients with HER2-positive breast cancer.
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  • 文章类型: Historical Article
    背景:Liliequist膜(LM)代表了神经解剖学中至关重要但具有挑战性的解剖结构。首先在1875年观察到,后来在1956年由BengtLiliequist阐明,LM的精确解剖描述和边界仍然很复杂。它的意义延伸到神经外科,影响各种手术,如内窥镜第三脑室囊管造口术,动脉瘤和肿瘤手术,鞍上蛛网膜囊肿的治疗,管理中脑周围出血。然而,对LM的全面理解受到现有文献中不一致的解剖学描述和限制的阻碍,有必要进行系统的审查。
    方法:通过搜索PubMed,科学直接,和谷歌学者提供与利利奎斯特膜有关的文章。搜索采用网格术语,如\“Liliequist膜,\"\"Liliequist\"的隔膜,“和相关的变化。纳入标准包括探索历史演变的研究,解剖结构,放射学特征,以及LM在神经外科中的临床意义。
    结果:搜索产生了358篇文章,根据相关性筛选了276篇独特的文章。经过细致的筛选,72篇文章进行了全文评估,结果纳入了符合资格标准的5篇文章。选定的研究方法各不相同,包括解剖,放射学评估,以及在神经外科手术中的临床意义。对LM的解剖学变异的见解,放射学可视化,及其在指导神经外科干预方面的关键作用。
    结论:尽管在理解其临床意义和放射学可视化方面取得了进展,在精确划定其边界方面仍然存在挑战。进一步研究,特别是胚胎学发育和组织学特征,是必不可少的。增强对LM相关病理的理解对于神经外科手术中准确的术前计划和优化患者预后至关重要。
    The Liliequist membrane (LM) represents a crucial yet challenging anatomical structure in neuroanatomy. First observed in 1875 and later elucidated by Bengt Liliequist in 1956, the LM\'s precise anatomical description and boundaries remain complex. Its significance extends to neurosurgery, impacting various procedures like endoscopic third ventriculocisternostomies, aneurysm and tumor surgeries, treatment of suprasellar arachnoid cysts, and managing perimesencephalic hemorrhages. However, a comprehensive understanding of the LM is hindered by inconsistent anatomical descriptions and limitations in available literature, warranting a systematic review.
    A systematic review was conducted by searching PubMed, Science Direct, and Google Scholar for articles pertaining to Liliequist\'s membrane. The search employed Mesh terms like \"Liliequist membrane,\" \"Liliequist\'s diaphragm,\" and related variations. Inclusion criteria encompassed studies exploring the historical evolution, anatomical structure, radiological characteristics, and clinical implications of the LM in neurosurgery.
    The search yielded 358 articles, with 276 unique articles screened based on relevance. Following a meticulous screening process, 72 articles underwent full-text assessment, resulting in the inclusion of 5 articles meeting the eligibility criteria. The selected studies varied in methodology, including anatomical dissections, radiological evaluations, and clinical significance in neurosurgical procedures. Insights were derived on LM\'s anatomical variations, radiological visualization, and its critical role in guiding neurosurgical interventions.
    Despite advancements in understanding its clinical significance and radiological visualization, challenges persist in precisely delineating its boundaries. Further research, especially on embryological development and histological characterization, is essential. Enhancing comprehension of LM-related pathologies is crucial for accurate preoperative planning and optimizing patient outcomes in neurosurgery.
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  • 文章类型: Journal Article
    股骨远端骨折带来了巨大的骨科挑战,需要进行全面的流行病学探索,解剖学,分类,诊断,和治疗策略。这篇综述彻底分析了股骨远端骨折周围的多方面问题。它深入研究了定义和流行病学,在入射角上发光,年龄分布,和相关的危险因素。彻底检查股骨远端的解剖结构,包括韧带和肌腱,根据AO基金会/骨科创伤协会(AO/OTA)系统,为理解骨折模式和随后的分类奠定了基础。诊断考虑包括体格检查和各种成像方式,强调迅速和准确评估的关键重要性。关于治疗方案的广泛讨论包括非手术管理,包括铸造和牵引,外科手术干预,如切开复位和内固定,髓内钉,和外固定。临床实践的意义强调了基于骨折特征的定制方法以优化患者预后的必要性。然而,这次审查还强调了需要进一步调查的领域,包括探索预测性生物标志物,先进的外科技术,和创新的康复方案。来自不同人群的长期结果和生活质量评估的见解为加强股骨远端骨折的综合管理提供了有希望的途径。这些领域的持续研究可以完善治疗策略,并提高应对这种复杂骨科疾病的个人的护理标准。
    Distal femur fractures present a substantial orthopedic challenge, necessitating a comprehensive exploration spanning epidemiology, anatomy, classification, diagnosis, and treatment strategies. This review thoroughly analyzes the multifaceted aspects surrounding distal femur fractures. It delves into the definition and epidemiology, shedding light on the incidence, age distribution, and associated risk factors. An exhaustive examination of the distal femur\'s anatomy, encompassing ligaments and tendons, establishes the groundwork for understanding fracture patterns and subsequent classification according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) system. Diagnostic considerations encompass physical examination and various imaging modalities, emphasizing the critical importance of prompt and accurate assessment. The extensive discussion on treatment options ranges from non-surgical management, including casting and traction, to surgical interventions, such as open reduction and internal fixation, intramedullary nailing, and external fixation. The implications for clinical practice underscore the necessity for tailored approaches based on fracture characteristics to optimize patient outcomes. However, this review also emphasizes areas necessitating further investigation, including exploring predictive biomarkers, advanced surgical techniques, and innovative rehabilitation protocols. Insights from long-term outcomes and quality-of-life assessments in diverse populations offer promising avenues for enhancing the comprehensive management of distal femur fractures. Continuous research in these areas can refine treatment strategies and elevate the standard of care for individuals grappling with this intricate orthopedic condition.
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  • 文章类型: Journal Article
    糖尿病性视网膜病变(DR)是全球视力障碍的主要原因,需要全面了解其血管和神经成分,以进行有效的治疗干预。虽然血管病理学已经确立,最近的证据表明在DR中具有神经退行性作用。血管内皮生长因子(VEGF),传统上涉及血管生成,已经成为具有神经保护潜力的关键人物。本系统综述对文献进行了评估,以阐明这方面的分子机制和临床意义。审查遵循系统审查和荟萃分析(PRISMA)指南的首选报告项目,涵盖跨多个数据库的全面搜索策略。三项体外研究符合纳入标准,突出了这个不断发展的领域有限的研究。研究结果表明VEGF对视网膜神经节细胞(RGCs)和视网膜神经元的神经保护作用,揭示潜在的治疗途径。然而,人们对抗VEGF治疗对RGC生存的影响表示担忧。该综述讨论了需要进一步研究来描述负责VEGF介导的神经保护的特定同工型和信号通路。血管生成和神经保护之间的微妙平衡对治疗发展提出了挑战。强调有针对性干预的重要性。尽管有局限性,这篇综述提供了关于VEGF与DR神经保护之间复杂关系的有价值的见解,为未来的研究和重新定义治疗策略铺平道路。
    Diabetic retinopathy (DR) is a leading cause of global visual impairment, necessitating a comprehensive understanding of its vascular and neural components for effective therapeutic interventions. While vascular pathology is well-established, recent evidence suggests a neurodegenerative role in DR. Vascular endothelial growth factor (VEGF), traditionally implicated in angiogenesis, has emerged as a key player with neuroprotective potential. This systematic review evaluates the literature to shed light on molecular mechanisms and clinical implications in this regard. The review adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, encompassing a thorough search strategy across multiple databases. Three in vitro studies met the inclusion criteria, highlighting the limited research in this evolving field. Findings suggest VEGF\'s neuroprotective effects on retinal ganglion cells (RGCs) and retinal neurons, unveiling potential therapeutic avenues. However, concerns arise regarding anti-VEGF therapies\' impact on RGC survival. The review discusses the need for further research to delineate specific isoforms and signaling pathways responsible for VEGF-mediated neuroprotection. The delicate balance between angiogenesis and neuroprotection poses challenges in therapeutic development, emphasizing the importance of targeted interventions. Despite limitations, this review provides valuable insights into the intricate relationship between VEGF and neuroprotection in DR, paving the way for future investigations and redefining therapeutic strategies.
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  • 文章类型: Journal Article
    低钠血症是一种常见的电解质异常,具有重要的预后和治疗意义。它可能对包括中枢神经系统(CNS)在内的各种器官系统产生有害影响。骨头,和心脏及其与生活质量差的潜在联系。这些不利影响可能主要是通过多种机制介导的,包括渗透胁迫,功能失调的跨膜交换器,和增强的氧化应激。有趣的是,低钠血症也可能与Takotsubo综合征(TTS)有重要关联,TTS被普遍认为是一种可逆形式的心肌病,通常是在各种应激源下出现的。在这种情况下,之前有报道称,严重低钠血症是TTS进化的直接触发因素,主要是由于其对中枢神经系统和心脏的潜在影响.然而,TTS患者低钠血症的发病机制和临床意义仍需全面评估.本文旨在分析主要由低钠血症引发的TTS的临床特征,并从更广泛的角度讨论低钠血症与TTS之间的关系。
    Hyponatremia is a common electrolyte abnormality with important prognostic and therapeutic implications. It might exert detrimental effects on various organ systems including the central nervous system (CNS), bone, and heart along with its potential association with poor quality of life. These adverse effects might be largely mediated through a variety of mechanisms including osmotic stress, dysfunctional transmembrane exchangers, and enhanced oxidative stress.Interestingly, hyponatremia might also have an important association with takotsubo syndrome (TTS) that has been universally considered as a reversible form of cardiomyopathy usually emerging in response to various stressors. In this context, severe hyponatremia was previously reported to serve as a direct trigger of TTS evolution largely through its potential impact on CNS and heart. However, pathogenetic and clinical implications of hyponatremia still need to be thoroughly evaluated in patients with TTS. This paper aims to analyze the clinical features of published cases with TTS primarily triggered by hyponatremia and also aims to discuss the association between hyponatremia and TTS from a broader perspective.
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  • 文章类型: Journal Article
    电解质异常在急性中风患者中很常见,对疾病的病程和预后有重大影响。电解质失衡,如低钠血症,低钾血症,低钙血症,低镁血症,和磷酸盐异常常见于该患者人群。发病率,根本原因,在这项综合研究中,研究了急性中风患者电解质异常的医学后果。根据我们的研究,低钠血症是最常见的电解质失衡。中风患者低钠血症的最常见原因是抗利尿激素分泌不当综合征(SIADH)。死亡率较高,住院时间更长,和较差的功能结局都与低钠血症有关。急性中风患者通常也会出现低钾血症,影响中风的严重程度和功能能力的恢复。该综述进一步强调了高钙血症的发生率和临床后果,低镁血症,低磷酸盐血症,急性中风患者的低钙血症。结果突出了早期电解质失衡检测和治疗在急性脑卒中患者中的意义。为了更好地理解治疗方法,评估它们对卒中结局的影响,并分析预后影响,需要更多的研究。
    Electrolyte abnormalities are common in acute stroke patients and have a substantial impact on the course and prognosis of the disease. Electrolyte imbalances such as hyponatremia, hypokalemia, hypocalcemia, hypomagnesemia, and phosphate abnormalities are frequently seen in this patient population. The incidence, root causes, and medical ramifications of electrolyte abnormalities in acute stroke patients are investigated in this comprehensive study. According to our research, hyponatremia is the most prevalent electrolyte imbalance. The most common reason for hyponatremia in stroke patients is the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Higher mortality rates, longer hospital admissions, and less favorable functional outcomes are all linked to hyponatremia. Acute stroke patients also typically experience hypokalemia, which affects the severity of the stroke and the recovery of functional abilities. The review furthermore emphasizes the incidence and clinical consequences of hypercalcemia, hypomagnesemia, hypophosphatemia, and hypocalcemia in patients with acute stroke. The results highlight the significance of early electrolyte imbalance detection and treatment in acute stroke patients. To better comprehend therapeutic approaches, evaluate their influence on stroke outcomes, and analyze prognostic implications, more research is required.
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  • 文章类型: Journal Article
    早产,被认为是在妊娠37周前开始分娩,是产科中一个非常普遍的问题,对新生儿健康有影响。本文对血清镁水平与早产之间的关系进行了深入分析。这篇综述探讨了镁在怀孕期间的生理作用,包括它对能量代谢的意义,平滑肌收缩,脱氧核糖核酸(DNA),和蛋白质合成。它解决了细胞运输和镁的稳态。包括炎症的病理生理过程,氧化应激,钙调节,平滑肌收缩性,和神经内分泌途径进行了研究。该综述评估了流行病学研究,调查了血清镁水平与早产之间的关系。该评论纳入了各种研究品种,比如观察性研究,病例对照研究,前瞻性队列研究,和荟萃分析。在回顾血清镁水平与早产的预后相关性的过程中,涉及诊断精度的治疗意义,预后意义,和治疗反应评估也得到了解决。针对镁水平的治疗干预措施,比如补充镁,宫缩疗法,以及镁在产前皮质类固醇给药中的作用,正在探索。本文综述了血清镁水平与早产的相关性,强调其治疗意义和对未来研究和治疗策略的影响。
    Preterm labor, regarded as the onset of labor before 37 weeks of gestation, is a highly prevalent issue in obstetrics with repercussions for neonatal health. This review article presents an in-depth analysis of the alliance between serum magnesium levels and preterm labor. The review explores the physiological roles of magnesium right through pregnancy, including its significance for energy metabolism, smooth muscle contraction, deoxyribonucleic acid (DNA), and protein synthesis. It addresses cellular transport and the homeostasis of magnesium. The pathophysiological processes encompassing inflammation, oxidative stress, calcium regulation, smooth muscle contractility, and neuroendocrine pathways are investigated. The review evaluates epidemiological studies investigating the alliance between serum magnesium levels and preterm labor. The review incorporates an assortment of study varieties, such as observational studies, case-control studies, prospective cohort studies, and meta-analyses. In the course of reviewing the prognostic relevance of serum magnesium levels in premature labor, therapeutic implications involving diagnostic precision, prognostic significance, and therapeutic response assessment have additionally been addressed. Therapeutic interventions targeting magnesium levels, such as magnesium supplementation, tocolytic therapy, and the role of magnesium in antenatal corticosteroid administration, are explored. This review provides an in-depth evaluation of the correlation between serum magnesium levels and preterm labor, stressing its therapeutic significance and repercussions for future research and treatment strategies.
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  • 文章类型: Case Reports
    小肠的原发性和转移性癌很少见。虽然这些恶性肿瘤大多是腺癌,胃肠道鳞状细胞癌(SCC)并不常见。我们提供了一例罕见的皮肤SCC转移到回肠的病例报告,强调诊断挑战和临床意义。
    方法:一名83岁的女性在急诊就诊前两年有右侧颞区皮肤SCC切除史,随后在接受放射治疗的右侧腮腺内淋巴结转移复发。患者出现感染性休克和急腹症,腹部计算机断层扫描显示肠穿孔的迹象。急诊剖腹探查术证实化脓性腹膜炎和末端回肠穿孔。随后,进行了20厘米的肠切除术。切除标本的组织病理学检查显示小肠有4厘米穿孔的SCC(pT4pN0L0V1Pn0R0)。
    小肠的转移很少见。这些转移的主要部位通常是子宫,子宫颈,结肠,肺,乳房,或者黑色素瘤.小肠的SCC特别罕见,并且由于非特异性症状而在诊断中提出了挑战。小肠SCC的预后通常较差,某些皮肤SCC的潜在攻击行为强调了在处理此类病例时需要提高意识和警惕。
    结论:本病例报告强调,对于有皮肤SCC病史并出现新发腹部症状的患者,考虑小肠转移性疾病的重要性。
    UNASSIGNED: Primary and metastatic carcinoma of the small intestine are rare. While most of these malignancies are adenocarcinomas, squamous cell carcinoma (SCC) of the gastrointestinal tract is uncommon. We present a case report of a rare occurrence of skin SCC metastasizing to the ileum, highlighting diagnostic challenges and clinical implications.
    METHODS: An 83-year-old female had a history of cutaneous SCC excision in the right temporal region two years prior to the current emergency department visit, followed by metastatic recurrence in a right intra-parotid lymph node treated with radiotherapy. The patient exhibited septic shock and an acute abdomen, and an abdominal computed tomography scan revealed signs of intestinal perforation. Emergency exploratory laparotomy confirmed purulent peritonitis and perforation of the terminal ileum. Subsequently, a 20 cm intestinal resection was performed. Histopathological examination of the resected specimen revealed a 4 cm perforated SCC of the small intestine (pT4 pN0 L0 V1 Pn0 R0).
    UNASSIGNED: Metastases of the small intestine are rare. The primary sites for these metastases are typically the uterus, cervix, colon, lung, breast, or melanoma. SCC of the small intestine is particularly rare and poses challenges in diagnosis owing to non-specific symptoms. The prognosis for SCC of the small intestine is generally poor, and the potentially aggressive behavior of some skin SCC emphasizes the need for increased awareness and vigilance in managing such cases.
    CONCLUSIONS: This case report underscores the importance of considering metastatic disease in the small bowel of patients with a history of skin SCC who present with new-onset abdominal symptoms.
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