Daily Medical Practice Research Articles

Getting by with a little help from my friends? Expanding mentorship for career development and satisfaction

Collaboration and teamwork are well-established cornerstones of modern clinical and academic medicine as well as research, including radiology. Mentorship is also part and parcel of daily medical practice and training. As it is, there is a wide range of opinions on the effectiveness of standard mentorship models. In some cases, academic departments may offer mentorship to fulfill a requirement rather than as a sign of commitment to ensuring that all mentees receive the guidance they seek. Although mentor-mentee relationships might have arisen organically, and such situations are still possible, the overall lack of face-to-face interactions in many departments in the COVID era suggests the need to emphasize formal mentoring programs. We appreciate the overall successes of mentorship in medicine as well as radiology, while acknowledging that, like anything, it is not perfect. Because the processes of decision making and career planning are similar across fields, a peer-to-peer cross-specialty mentorship model could yield untold benefits to early-career radiologists who may receive valuable advice from friends or colleagues outside of medicine, or simply outside of radiology, at crucial points in their careers. There is no ideal formula or format for mentoring, however. We endorse the theory or intentions of mentorship and believe that its effectiveness can take several forms. Having a formal program in place, with built-in flexibility to address our rapidly changing times, remains highly desirable. Our proposal is to expand this notion to a “whatever works,” “anything goes,” or, in the spirit of the COVID era, a hybrid model.

Evidence-based Medicine: Perceptions, Attitudes, and Skills Among European Urology Residents

BackgroundEvidence-based medicine (EBM) was introduced as a concept in the early 1990s as an integration of the best available evidence with clinical expertise and patient values. ObjectiveTo evaluate the current status of EBM training and EBM perception, attitudes, and self-perceived skills among European urology residents. Design, setting, and participantsOur online open survey comprised 28 multiple-choice items, including ten questions with responses on a five-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree. The survey was distributed via the mailing lists and social media accounts of the European Society of Residents in Urology, German Society of Residents in Urology, French Society of Urologists in Training, Spanish Urology Residents Working Group, Italian Society of Residents in Urology, and the Urology Social Media Working Group in two rounds (May–July 2019 and July 2020). We excluded responses from non-European countries. Outcome measurements and statistical analysisThe online open survey comprised 28 multiple-choice items. These included ten questions with answers on a five-point Likert scale with response items ranging from strongly disagree (score of 1) to strongly agree (score of 5). Results and limitationsWe received 210 responses, of which 181 from 23 European countries were eligible. Approximately three-quarters (73.7%) of the respondents were male, with a mean age of 31 yr. Only 28.2% reported EBM training as part of their urology curriculum and 19.3% felt that the training they received was sufficient to guide their daily practice. An overwhelming majority (91.5%) stated that they would be interested in more formalized EBM training or additional training. There was a strong level of agreement (median score 5, interquartile range 4–5) that EBM is important for daily medical and surgical practice and that it improves patient care. Overall, the mean self-perceived understanding of basic EBM concepts was good. Limitations include concerns about generalizability given its internet-based format, the inability to calculate a response rate, poor representation from some European regions, and limited sample size. ConclusionsOur survey suggests that European urology residents receive a limited amount of EBM training despite considerable appreciation, interest, and self-perceived deficits for more advanced concepts. Formal integration of EBM teaching in all European residency programs should be considered. Patient summaryWe performed an online survey of urology residents in Europe. We found that residents have positive perceptions of and attitudes to evidence-based medicine but most programs lack formal training in this area.

Evaluation of medical decision support systems (DDX generators) using real medical cases of varying complexity and origin

BackgroundMedical decision support systems (CDSSs) are increasingly used in medicine, but their utility in daily medical practice is difficult to evaluate. One variant of CDSS is a generator of differential diagnoses (DDx generator). We performed a feasibility study on three different, publicly available data sets of medical cases in order to identify the frequency in which two different DDx generators provide helpful information (either by providing a list of differential diagnosis or recognizing the expert diagnosis if available) for a given case report.MethodsUsed data sets were n = 105 cases from a web-based forum of telemedicine with real life cases from Afghanistan (Afghan data set; AD), n = 124 cases discussed in a web-based medical forum (Coliquio data set; CD). Both websites are restricted for medical professionals only. The third data set consisted 50 special case reports published in the New England Journal of Medicine (NEJM). After keyword extraction, data were entered into two different DDx generators (IsabelHealth (IH), Memem7 (M7)) to examine differences in target diagnosis recognition and physician-rated usefulness between DDx generators.ResultsBoth DDx generators detected the target diagnosis equally successfully (all cases: M7, 83/170 (49%); IH 90/170 (53%), NEJM: M7, 28/50 (56%); IH, 34/50 (68%); differences n.s.). Differences occurred in AD, where detection of an expert diagnosis was less successful with IH than with M7 (29.7% vs. 54.1%, p = 0.003). In contrast, in CD IH performed significantly better than M7 (73.9% vs. 32.6%, p = 0.021). Congruent identification of target diagnosis occurred in only 46/170 (27.1%) of cases. However, a qualitative analysis of the DDx results revealed useful complements from using the two systems in parallel.ConclusionBoth DDx systems IsabelHealth and Memem7 provided substantial help in finding a helpful list of differential diagnoses or identifying the target diagnosis either in standard cases or complicated and rare cases. Our pilot study highlights the need for different levels of complexity and types of real-world medical test cases, as there are significant differences between DDx generators away from traditional case reports. Combining different results from DDx generators seems to be a possible approach for future review and use of the systems.

Patient experience and decisional satisfaction with the informed consent process for elective gynecologic surgeries: A cross-sectional study

BackgroundThe informed consent process is a vital component of daily medical practice. It involves providing patients with sufficient, accurate, and understandable information to decide on a contemplated therapy. The study aims to evaluate the patient experience and satisfaction with the preoperative informed consent process. MethodsA cross-sectional study was performed on adult women admitted for elective gynecologic surgery in a tertiary training hospital. Participants were recruited on their second postoperative day and were asked to answer a structured questionnaire assessing decisional satisfaction and experience with the informed consent process. Satisfaction was measured using a 6-item Satisfaction with Decision Scale. Knowledge of the surgery and experience with the informed consent were measured using an Informed Consent Questionnaire. Bivariate associations between highly satisfied and not highly satisfied groups were tested using Fisher exact test. ResultsA total of 150 patients were enrolled in the study with a mean age of 44.5 years. The resident-in-charge provided the information and assisted in the documentation of the informed consent in 86.7% and 67.3% of patients, respectively. There was an overall high decisional satisfaction with a mean score of 27.4 and 52.7% of patients strongly agreeing to all statements of the Satisfaction with Decision Scale. The majority of the respondents were informed and acknowledged comprehension of the surgery including its risks, benefits, and alternative treatment options. Knowing the success rate and benefits of the procedure as well as being informed of the need for postoperative catheterization were significantly associated with high satisfaction. ConclusionKnowledge and understanding of the key components of informed consent influence patient satisfaction. The current study highlights the high decisional satisfaction rates of patients who underwent elective gynecologic surgery. Strategies to further improve this patient-physician encounter include the establishment of standard policies on personnel involved, timing, and quality of information given to patients. Patient satisfaction should serve as an indicator of the quality of healthcare rendered and guide for continuous improvement of services.

Microplastic and dermatological care

HintergrundKunststoffe aus fossilen Rohstoffen (Plastik) werden in großer Menge hergestellt und gelangen bei unsachgemäßer Entsorgung und über weitere Eintragspfade in die Umwelt. Dies kann Auswirkungen auf Flora, Fauna und den Menschen zur Folge haben.Ziel der ArbeitDie vorliegende Arbeit soll Dermatolog*innen einen kompakten Überblick über diese komplexe Thematik und den Zusammenhang zur täglichen ärztlichen Tätigkeit bieten.Material und MethodenEs erfolgte eine selektive Literaturrecherche zu den Themen Mikroplastik und Nachhaltigkeit in der Dermatologie unter Einbezug des Sonderforschungsbereichs 1357 Mikroplastik der Universität Bayreuth.ErgebnissePrimäres und sekundäres Mikroplastik gelangt in großen Mengen in die Umwelt und akkumuliert in aquatischen und terrestrischen Ökosystemen. Dies kann zur Disruption selbiger führen und ökologische Nischen für humanpathogene Spezies schaffen. Menschen und Tiere nehmen Mikroplastik über die Atemwege und die Nahrung zu sich, die gesundheitlichen Folgen sind nicht ausreichend erforscht. Dies liegt v. a. darin begründet, dass Mikroplastik keine einheitliche Stoffgruppe ist und mögliche Effekte von vielen unterschiedlichen Eigenschaften der Partikel abhängen (z. B. Polymertyp, Größe, Form, Additivierung, Oberflächenladung). Die dermatologische Versorgung ist ressourcenintensiv und trägt auf unterschiedliche Weise zur geschilderten Gesamtproblematik bei.DiskussionKunststoffe sind aktuell in vielen Bereichen unverzichtbar. Nichtsdestoweniger haben Ärzt*innen die Verantwortung, negative Folgen für die Gesundheit der Bevölkerung abzuwenden (Vorsorgeprinzip). Es sind daher weitreichende Anstrengungen für mehr Nachhaltigkeit notwendig, dies schließt auch die ärztliche Routineversorgung mit ein.

Enquête sur la pratique de la téléconsultation médicale en oncologie en Auvergne Rhône Alpes

Teleconsultation (TLC) practice, which suddenly arrived in the cancer patients care, has experienced an undeniable quantitative boom given the health context. A quantitative and qualitative assessment of this practice now seems necessary. This study aims to describe the use of TLC by oncologists in the Auvergne-Rhône-Alpes region during the pandemic in order to assess its advantages and limits, and to estimate the barriers encountered and the possible levers for its promotion in oncology. The use of TLC in daily medical practice was evaluated using a descriptive observational survey from October to December 2021. Health's professionals were invited to answer an online survey composed of around thirty questions. Of the 200 oncologists contacted, 72 took part in the survey. Among them, 64 have already made at least one TLC. TLCs represented 25% of consultations during the confinement period. New cancer patients, the fact of not seeing the patient physically and the absence of the possibility of carrying out a physical examination are the 3 main obstacles to TLC. The mastery of computer tools is one of the main levers. All cancer patients appear eligible for TLC; the professionals surveyed prefer this solution for certain socio-demographic and medical characteristics of the patients (the fact of living far from the cancer centre, of having a stable clinical situation, of being under surveillance or being treated with oral anti-cancer drugs…). Despite a median level of satisfaction of 63% estimated by doctors, less than 10% of medical consultations are currently kept in TLC. TLC is now an integrated practice in oncology but seems more relevant for a specific patient profile and clinical situation. In addition, technical and training constraints still limit its use in clinical practice today.

Epidemiology and natural history of non-metastatic castration-resistant prostate cancer in Russia

Aim. To study the clinical and demographic profile of patients with non-metatstatic castration-resistant prostate cancer (nmCRPC) and clinical approaches to the treatment of nmCRPC in the context of daily medical practice before and after progression M1 stage.Materials and methods. The multicenter non-interventional epidemiological study were included 200 patients with a documented diagnosis of nmCRPC from 2019 to 2020. Each patient visited twice: start and after 6 months. Of the 200 patients included, 9 were excluded from the analysis presented in this article: 1 patient had no information on inclusi- on criteria, 1 patient did not meet the inclusion criteria, 7 patients did not attend visit 2. Thus, data are presented for 191 patients.Results and conclusion. The median age was 74.3 years (range 55 to 91). 72 % (137/191) had a disability group. The most common comorbidities were hypertension (n = 115) and hypercholesterolemia (n = 56). The median time from the diagnosis of prostate cancer to the development of castration resistance (diagnosis of nmCRPC) was 75 months. Prostate specific antigen (PSA) nadir (0.37 ng/ml on average) was achieved after 15 months of prostate cancer therapy (median time to reach PSA nadir). At the same time, PSA doubling time in most cases (47.6 %; 91/191) was less than 6 months, 18.8 % of persons (36/191) had PSA doubling time for more than 10 months.

Mirau-based line-field confocal optical coherence tomography for three-dimensional high-resolution skin imaging.

SignificanceLine-field confocal optical coherence tomography (LC-OCT) is a recently introduced high-resolution imaging modality based on a combination of low-coherence optical interferometry and reflectance confocal optical microscopy with line illumination and line detection. Capable of producing three-dimensional (3D) images of the skin with cellular resolution, in vivo, LC-OCT has been mainly applied in dermatology and dermo-cosmetology. The LC-OCT devices capable of acquiring 3D images reported so far are based on a Linnik interferometer using two identical microscope objectives. In this configuration, LC-OCT cannot be designed to be a very compact and light device, and the image acquisition speed is limited.AimThe objective of this work was to develop a more compact and lighter LC-OCT device that is capable of acquiring images faster without significant degradation of the resolution and with optimized detection sensitivity.ApproachWe developed an LC-OCT device based on a Mirau interferometer using a single objective. Dynamic adjustment of the camera frequency during the depth scan is implemented, using a faster camera and a more powerful light source. The reflectivity of the beam-splitter in the Mirau interferometer was optimized to maximize the detection sensitivity. A galvanometer scanner was incorporated into the device for scanning the illumination line laterally. A stack of adjacent B-scans, constituting a 3D image, can thus be acquired.ResultsThe device is able to acquire and display B-scans at 17 fps. 3D images with a quasi-isotropic resolution of (1.3, 1.9, and in the , and directions, respectively) over a field of () can be obtained. 3D imaging of human skin at cellular resolution, in vivo, is reported.ConclusionsThe acquisition rate of the B-scans, at 17 fps, is unprecedented in LC-OCT. Compared with the conventional LC-OCT devices based on a Linnik interferometer, the reported Mirau-based LC-OCT device can acquire B-scans times faster. With potential advantages in terms of compactness and weight, a Mirau-based device could easily be integrated into a smaller and lighter handheld probe for use by dermatologists in their daily medical practice.

Artificial intelligence in medical education curriculum: An e-Delphi study for competencies.

BackgroundArtificial intelligence (AI) has affected our day-to-day in a great extent. Healthcare industry is one of the mainstream fields among those and produced a noticeable change in treatment and education. Medical students must comprehend well why AI technologies mediate and frame their decisions on medical issues. Formalizing of instruction on AI concepts can facilitate learners to grasp AI outcomes in association with their sensory perceptions and thinking in the dynamic and ambiguous reality of daily medical practice. The purpose of this study is to provide consensus on the competencies required by medical graduates to be ready for artificial intelligence technologies and possible applications in medicine and reporting the results.Materials and methodsA three-round e-Delphi survey was conducted between February 2020 and November 2020. The Delphi panel accorporated experts from different backgrounds; (i) healthcare professionals/ academicians; (ii) computer and data science professionals/ academics; (iii) law and ethics professionals/ academics; and (iv) medical students. Round 1 in the Delphi survey began with exploratory open-ended questions. Responses received in the first round evaluated and refined to a 27-item questionnaire which then sent to the experts to be rated using a 7-point Likert type scale (1: Strongly Disagree—7: Strongly Agree). Similar to the second round, the participants repeated their assessments in the third round by using the second-round analysis. The agreement level and strength of the consensus was decided based on third phase results. Median scores was used to calculate the agreement level and the interquartile range (IQR) was used for determining the strength of the consensus.ResultsAmong 128 invitees, a total of 94 agreed to become members of the expert panel. Of them 75 (79.8%) completed the Round 1 questionnaire, 69/75 (92.0%) completed the Round 2 and 60/69 (87.0%) responded to the Round 3. There was a strong agreement on the 23 items and weak agreement on the 4 items.ConclusionsThis study has provided a consensus list of the competencies required by the medical graduates to be ready for AI implications that would bring new perspectives to medical education curricula. The unique feature of the current research is providing a guiding role in integrating AI into curriculum processes, syllabus content and training of medical students.

Successful Laparoscopic Retrieval of an Accidental Intra - Abdominal Sewing Needle – A Case Report

Accidental ingestion of sewing needle is a common presentation in daily emergency medical practice but its insertion through the abdominal wall is quite rare. We present a case of 26 years old serving soldier who had an accidental intraabdominal insertion of sewing needle which was managed laparoscopically. Initially patient was asymptomatic, however he complained of lower abdominal pain later. This was followed by successful laparoscopic retrieval of sewing needle located in right iliac fossa with no documented complications during six months of follow-up of the patient.

The Impact of COVID-19 on the Daily Life and Medical Practice of Otolaryngology Physicians.

Introduction The coronavirus disease 2019 (COVID-19) has made otolaryngologists more susceptible than their counterparts to its effect. Objective This study aimed to find if COVID-19 had a different impact on ear, nose, and throat (ENT) physicians' of various categories (residents, registrars, and consultants ) regarding many aspects of the quality of life (protection, training, financial, and psychological aspects). Methods We included 375 ENT physicians, of different categories (residents, registrars, and consultants), from 33 general hospitals and 26 university hospitals in Egypt. The study was conducted using a 20-item questionnaire with a response scale consisting of three categories: yes, no, and not sure. It covered infection control and personal protective equipment (PPE) usage; medical practice and safety; online consultation and telemedicine,; webinars and online lectures; COVID-19 psychological, financial, and quarantine period effects; and future expectations. Results The results of the questionnaire showed that COVID-19 had a statistically significant impact on the daily life of the responders. There were statistically significant differences among the three involved categories, based on their answers. Conclusion This study showed a statistically significant difference regarding the impact of COVID-19 on many aspects of the quality of life (protection, training, financial, and psychological aspects) of ENT physicians of various categories (residents, registrars, and consultants), and these effects may persist for a long time.

Applications of artificial intelligence in obstetrics.

Artificial intelligence, which has been applied as an innovative technology in multiple fields of healthcare, analyzes large amounts of data to assist in disease prediction, prevention, and diagnosis, as well as in patient monitoring. In obstetrics, artificial intelligence has been actively applied and integrated into our daily medical practice. This review provides an overview of artificial intelligence systems currently used for obstetric diagnostic purposes, such as fetal cardiotocography, ultrasonography, and magnetic resonance imaging, and demonstrates how these methods have been developed and clinically applied.

Surgeon-performed ultrasound-guided head and neck procedures during COVID-19 pandemic

BackgroundThe ultrasonographic procedure is a common diagnostic and therapeutic method in daily medical practice. Surgeon-performed ultrasound (SUS) has been gaining popularity, especially during this COVID-19 pandemic.MethodsTwo ENT surgeons performed US-guided diagnostic or therapeutic procedures in the outpatient clinic. A successful SUS is defined as the diagnostic procedure's ability to facilitate the final histopathological diagnosis that can guide the subsequent treatment and disease resolution following the therapeutic procedure without the need for more invasive open surgical intervention.ResultsOut of 10 participants, 6 are males, and 4 are females. There were no complications noted. All subjects had successful tissue sampling or intervention on the first attempt for diagnostic and therapeutic SUS.ConclusionsWith COVID-19, there has been a significant shift in ordinary medical practice. SUS is proven to be a safe and effective method to facilitate the management of head and neck pathologies.

Measurement and Interpretation of Fractional Exhaled Nitric Oxide

Nitric oxide is produced by the human lungs and increases in response to type 2 inflammation. The level of fractional exhaled nitric oxide (FeNO) may reflect type 2 inflammation in the airways, which is related to eosinophilic inflammation and treatment responsiveness to corticosteroids. The FeNO test is a non-invasive, simple, and safe point-of-care test to evaluate airway inflammation. It has been standardized for clinical use and has been widely utilized in daily medical practice. However, various intrinsic and extrinsic factors can affect FeNO levels, and understanding and controlling such factors will improve the utility of this measure. The FeNO test can be used to confirm an asthma diagnosis, predict treatment responses to corticosteroids, and guide inhaled corticosteroid therapy for asthma treatment.

Development and psychometric properties of the human papillomavirus-quality of life (HPV-QoL) questionnaire to assess the impact of HPV on women health-related-quality-of-life

PurposeThe HPV-Quality-of-Life (HPV-QoL) questionnaire was developed to determine the impact of Human-Papillomavirus (HPV) infection and related interventions on women health-related quality-of-life. This study provides the development and preliminary psychometric properties of a novel HPV-QoL questionnaire for adult women with HPV.MethodsAfter reviewing literature and cognitive debriefing interviews in women who had experienced HPV-related conditions, instrument items and domains were developed. A draft questionnaire was pilot tested for comprehension and ease of completion. Psychometric evaluation of the final HPV-QoL scale was conducted in a psychometric study including 252 adult women derived to our centre by a positive HPV test in the cervical cancer screening program and/or presenting genital warts.ResultsThe present study reveals that the HPV-QoL questionnaire, structured in four domains: general well-being [including psychological well-being and social well-being subdomains], health, contagiousness and sexuality, showed good metric properties of feasibility irrespective of age or educational level, and time to administer was less than 5 min. Internal consistency and temporal stability (reliability) showed values above the acceptable standards. The instrument showed its concurrent validity by means of a significant correlation with mental and sexual existing instruments; GHQ-12 and FSFI questionnaires, respectively, and also known groups validity showing significant differences among the subgroups regarding either sexual dysfunction or mental deterioration.ConclusionThis study provides an HPV-QoL questionnaire with an innovative patient-reported outcomes specific measurement tool to assess HRQoL in women with HPV infection. The present study suggests this questionnaire has satisfactory psychometric properties, including validity and reliability. Results support the use of the HPV-QoL questionnaire as a HRQoL measurement instrument for daily medical practice and clinical research.

Characteristics of Drug-related Problems in Outpatients Based on Analyses of PreAVOID Reports by Community Pharmacists

PreAVOID, which refers to cases in which pharmacists avoid or reduce undesirable drug-related issues (eg, adverse drug reactions [ADRs], drug-drug interactions, and insufficient therapeutic effects) by pharmaceutical interventions, have been used as one of the indicators of pharmacists’ professional performance. In recent years, despite the efforts undertaken by community pharmacists to promote PreAVOID, PreAVOID reports by community pharmacists have not been adequately examined. In this study, we analyzed PreAVOID reports by community pharmacists to understand the characteristics of drug-related problems (DRPs) that required pharmaceutical interventions in outpatients and the profession of community pharmacists. We classified DRPs into eight categories and 33 subcategories and analyzed community pharmacists’ pharmaceutical interventions for various DRPs (eg, overdosage, duplication of drugs with similar effects, and history of ADRs). Of note, 70.9％ of the PreAVOID by community pharmacists led to the avoidance of ADRs, and it was estimated that interventions for the avoidance of ADRs in the reported cases alone potentially reduced medical costs by approximately JPY 83 million. These results indicate that community pharmacists contribute to the avoidance of undesirable pharmaceutical issues in patients, mainly by performing interventions that help prevent ADRs. The classification used for DRPs in daily medical practice in this study could help identify DRPs that could be resolved by community pharmacists.

Artificial Intelligence in Digestive Endoscopy-Where Are We and Where Are We Going?

Artificial intelligence, a computer-based concept that tries to mimic human thinking, is slowly becoming part of the endoscopy lab. It has developed considerably since the first attempt at developing an automated medical diagnostic tool, today being adopted in almost all medical fields, digestive endoscopy included. The detection rate of preneoplastic lesions (i.e., polyps) during colonoscopy may be increased with artificial intelligence assistance. It has also proven useful in detecting signs of ulcerative colitis activity. In upper digestive endoscopy, deep learning models may prove to be useful in the diagnosis and management of upper digestive tract diseases, such as gastroesophageal reflux disease, Barrett’s esophagus, and gastric cancer. As is the case with all new medical devices, there are challenges in the implementation in daily medical practice. The regulatory, economic, organizational culture, and language barriers between humans and machines are a few of them. Even so, many devices have been approved for use by their respective regulators. Future studies are currently striving to develop deep learning models that can replicate a growing amount of human brain activity. In conclusion, artificial intelligence may become an indispensable tool in digestive endoscopy.

The algorithm of stereo vision and shape from shading based on endoscope imaging

With medical endoscopic equipment development, minimally invasive surgery (MIS) has gradually become an essential technical means in daily medical practice. In recent years, minimally invasive surgery has been widely used because of its small incision and quick recovery. However, at the same time, minimally invasive surgery has put forward higher requirements for the operator. A 3D reconstruction framework combined with stereo vision and Shape from Shading (SFS) was proposed to improve endoscopic imaging accuracy and reduce the difficulty of minimally invasive surgery. This paper constructs a joint objective function based on the improved SFS and the classical stereo matching method. The optimization algorithm of the depth map under the joint objective function is given. Finally, the experimental verification of the joint reconstruction algorithm is carried out. The joint reconstruction framework's effectiveness is verified by qualitative and quantitative comparison and analysis based on the silica-gel-heart model and real-heart image datasets. The experimental results show that the joint reconstruction framework can restore the heart surface shape as a whole and retain the local details. Compared with the classical stereo vision and SFS methods, the proposed joint reconstruction method has better robustness and reconstruction accuracy.

Planning neurosurgical interventions in patients with anticoagulant therapy

Clinical practice guideline on anticoagulation is intended to manage patients undergoing neurosurgical procedures for the best possible short and long-term outcomes. In the clinical office practice, anticoagulation is offered to prevent thromboembolism with Warfarin, Heparin, Novel Oral Anticoagulants. The management approach starts with the mitigation plans from a reversal of pre-procedural anticoagulants for impending neurosurgical procedures by estimating procedural bleeding risk on the patients. The haemorrhage criteria and the timing of procedures are best assessed by the proceduralist during and after the intervention, standing on ground situations. Yet, intra- and post-procedure anticoagulant therapy should induct a multidisciplinary consultation paradigm for the best outcome in any emergent scenario. Further, each anticoagulation event should be monitored closely with competence in the optimum reversal process. Different neurosurgical procedures also should be weighed for their inherent hazards along with the probabilities of the bleeding and thromboembolism. The treating team should also concur to suggest a resumption of the pre-procedure anticoagulant therapy which may have been in place for altogether different morbidities. Regarding the anticoagulant agent, there are special conditions and recommendations to bear in mind in the daily medical practice for patient management. In the clinical practice guidelines for neurosurgical procedures, decisions about initiation and continuation of anticoagulants require experience and thorough internalization of the planned procedure, to avoid the risks of inherent risks of bleeding and thromboembolism.

Targeting Oncogenic Pathways in the Era of Personalized Oncology: A Systemic Analysis Reveals Highly Mutated Signaling Pathways in Cancer Patients and Potential Therapeutic Targets.

Simple SummaryCurrently, genomic databases offer a vast amount of information on mutational profiles and records of statistically significant genetic associations with diseases. However, the functional interpretation of frequently mutated genes implicated in cancer is essential for the development and clinical implementation of efficient targeted therapies. This review identifies and describes the most affected signaling pathways that are found deregulated in several cancer types and reports on corresponding targeted therapies, aiming to unravel literature gaps and to highlight targets of high therapeutic potential. To this purpose, we collected gene lists from the TCGA Pan-Cancer Atlas and OncoKB and employed the Onco Query Language (cBioPortal) search, to identify somatic driver events in 10,439 tumor samples. Each mutation was linked to the affected pathways and to the corresponding tumorigenic potential. Based on this analysis, the 10 most frequently mutated signaling pathways were selected for this review. A detailed description of the mechanistic implications of the identified mutations, as well as the corresponding cancer types and cognate therapeutic applications currently being employed or being under clinical investigation in clinical trials, is discussed. This review aims to explain how the utilization of available genomic mutation data can be employed for the development of targeted therapies, thereby advancing personalized medicine.Cancer is the second leading cause of death globally. One of the main hallmarks in cancer is the functional deregulation of crucial molecular pathways via driver genetic events that lead to abnormal gene expression, giving cells a selective growth advantage. Driver events are defined as mutations, fusions and copy number alterations that are causally implicated in oncogenesis. Molecular analysis on tissues that have originated from a wide range of anatomical areas has shown that mutations in different members of several pathways are implicated in different cancer types. In recent decades, significant efforts have been made to incorporate this knowledge into daily medical practice, providing substantial insight towards clinical diagnosis and personalized therapies. However, since there is still a strong need for more effective drug development, a deep understanding of the involved signaling mechanisms and the interconnections between these pathways is highly anticipated. Here, we perform a systemic analysis on cancer patients included in the Pan-Cancer Atlas project, with the aim to select the ten most highly mutated signaling pathways (p53, RTK-RAS, lipids metabolism, PI-3-Kinase/Akt, ubiquitination, b-catenin/Wnt, Notch, cell cycle, homology directed repair (HDR) and splicing) and to provide a detailed description of each pathway, along with the corresponding therapeutic applications currently being developed or applied. The ultimate scope is to review the current knowledge on highly mutated pathways and to address the attractive perspectives arising from ongoing experimental studies for the clinical implementation of personalized medicine.