Evidence Acquisition Research Articles

The Role of LncRNA ROR in Colorectal Cancer Diagnosis and Treatment

Context: Colorectal cancer (CRC) is one of the most common causes of cancer-related deaths worldwide, particularly in developed countries. Despite advances in detection and treatment, CRC remains difficult to diagnose in its early stages, complicating patient outcomes. Recently, long non-coding RNAs (lncRNAs) have emerged as significant regulators in cancer biology, offering new opportunities for cancer diagnostics. Evidence Acquisition: This review highlights the molecular mechanisms through which LncRNA ROR influences CRC development, its diagnostic potential as a biomarker, and the future challenges of integrating LncRNA ROR into clinical practice. Results: Future research must focus on large-scale validation studies and explore the therapeutic implications of targeting LncRNA ROR. Conclusions: Overall, this review positions LncRNA ROR as a promising biomarker with potential applications in both CRC diagnosis and treatment.

Integration of Hospital Dentistry in the Interdisciplinary Care of the Armed Forces: Perspectives and Practices

Context: This study aims to investigate the implementation and effectiveness of hospital dentistry (HD) in the Armed Forces, incorporating an integrative literature review and a detailed case report. It seeks to highlight the importance of an interdisciplinary approach to oral and systemic health in military patients, as well as identify significant gaps in current research that need to be addressed to achieve improved healthcare outcomes. Evidence Acquisition: An integrative review methodology was adopted, with articles selected through the PubMed/MEDLINE and Scielo databases using specific inclusion and exclusion criteria focused on the practice of HD in military settings. This approach ensured a comprehensive understanding of the existing literature. Simultaneously, a case report of an elderly patient treated within the military context was presented, detailing the diagnosis, intervention, and outcomes of HD, thus providing a practical example of the concepts discussed in the review. Results: The literature review revealed a scarcity of specific studies on HD in military settings, despite evidence highlighting the crucial role of an interdisciplinary team, including dentists, for the effective treatment of oral conditions affecting the overall health of patients. This lack of research underscores the need for further studies to address these gaps. The case report demonstrated the positive impact of HD on the patient's recovery, emphasizing the critical need for its integration into military healthcare to achieve improved patient outcomes. Conclusions: The integration of HD in military settings is essential but currently underutilized. The research emphasizes the need to develop and document HD practices that enhance both the oral and systemic health of military personnel, promoting a more comprehensive and interdisciplinary care approach. This integration can lead to better health outcomes, reduced hospital stays, and overall improved quality of life for military patients.

Posterior Tibial Nerve Stimulation Effect on Treatment of Overactive Bladder: A Systematic Review and Meta-analysis

Context: Overactive bladder (OAB) is a symptomatic syndrome indicative of lower urinary tract dysfunction. Current treatments for OAB syndrome include behavioral therapy, pharmacotherapy, minimally invasive procedures like sacral nerve stimulation and tibial nerve stimulation, as well as surgical options. Objectives: This systematic review aimed to evaluate the effectiveness of posterior tibial nerve stimulation (PTNS) as a treatment for OAB syndrome and to identify potentially effective stimulation methods. Evidence Acquisition: A systematic search was conducted using PubMed, Scopus, ProQuest, Web of Science, Google Scholar, and The Cochrane Library databases for predefined keywords. Two independent reviewers screened the studies’ titles, abstracts, and full texts. The quality of the studies was assessed using the JBI risk of bias (RoB) checklists. Studies meeting the inclusion criteria were summarized in an extraction table. Meta-analysis was performed using Review Manager Software. Results: Out of 2,282 studies identified, 63 were included in the data extraction table, and 19 of these were included in the meta-analysis to compare the effect of PTNS based on the number of treatment sessions (less than 12 sessions vs. 12 - 24 sessions). Despite heterogeneity among the studies, results showed a significant reduction in voiding frequency post-intervention (95% confidence interval, -4.25 to -1.48, P < 0.0001, Z = 4.06), with a greater reduction in the 12 - 24 sessions group (chi2 = 8.40, df = 1 (P < 0.004); I2 = 88.1%). Additionally, specific electrode placement methods further reduced voiding frequency after PTNS. Conclusions: Posterior tibial nerve stimulation can reduce voiding frequency in patients with OAB and painful bladder syndrome. However, establishing a standard PTNS method remains challenging due to variations among studies and the absence of control groups in many cases. Based on the results, PTNS with a frequency of 20 Hz, pulse duration of 200 µs, and stimulation intensity at the pain threshold appears effective for both transcutaneous and percutaneous techniques over 12 - 24 sessions. The percutaneous method may be more effective than the transcutaneous method.

The Strategies to Improve Primary Health Care Services: A Scoping Review

Context: Evaluation of health policies and identification of their challenges are vital for improving and implementing reforms in the healthcare system. The present study was conducted to identify interventions aimed at improving primary healthcare (PHC) services in Iran. Evidence Acquisition: This research utilizes a scoping review to examine reform interventions in PHC services across 10 selected countries: Qatar, Oman, Turkey, Georgia, Armenia, United Arab Emirates, Saudi Arabia, Bahrain, Kazakhstan, and Kuwait. The study covers areas such as the PHC delivery system, human resource management, financial mechanisms, and the framework of community participation and intersectoral collaboration from 2010 to 2022. Results: The main reform strategies for PHC systems in the reviewed countries included the establishment of family medical centers with nurse support as a comprehensive strategy for service provision in public health centers; providing comprehensive and quality healthcare service packages including maternal and child health, infectious disease immunization, chronic disease monitoring, and dental care services; health education; access to essential medications; improvement of electronic health services; implementation of health promotion and continuous prevention programs; capacity enhancement; and a greater focus on health screening programs and grading of healthcare centers. Conclusions: The major findings from the reviewed countries indicate that healthcare policymakers focus on providing preventive care services, reducing maternal and child mortality, and increasing life expectancy. Programs such as referral systems, service grading, and the adoption of electronic health services are part of their reform agenda.

A Deep Dive into Magnet AXIOM's Workflow: Exploring the Roles of AXIOM Process and AXIOM Examine in Digital Evidence Acquisition and Analysis

This research investigates the capabilities of Magnet AXIOM in the acquisition and analysis of digital evidence. It emphasizes the significance of both AXIOM Process and AXIOM Examine within contemporary forensic investigations, particularly in law enforcement settings. The study delves into how AXIOM’s functionalities—including logical, physical, and cloud-based acquisitions—enhance the process of evidence gathering. Furthermore, it examines how AXIOM Examine facilitates the thorough analysis of these acquisitions. By streamlining the processes of digital evidence acquisition and analysis, AXIOM has transformed crime investigations, enabling law enforcement agencies to conduct comprehensive and precise investigations efficiently.

Posture and Its Influence on Anatomical Structures: A Comprehensive Review

Objective: Posture refers to the alignment and positioning of body segments such as the head, trunk, and limbs in relation to the line of gravity during various activities. In essence, posture represents the body's alignment. In daily life, posture is often overlooked, despite its significant impact on our psychosocial well-being, physical health, activities, and even success. Upon examining the postural structure, it becomes evident that posture is directly related to various anatomical structures, whether we are sitting, standing, or engaged in other activities. Prolonged poor posture can negatively affect numerous anatomical structures, particularly muscles. This often neglected aspect is of considerable importance throughout our lives, and it plays a key role in our overall well-being. Evidence Acquisition: This study was conducted through a review of relevant literature. The findings were derived by compiling studies published between 2014 and 2024 using the keywords "posture and anatomy," "posture and musculoskeletal system" from PubMed, Web of Science, and Google Scholar databases. After screening, nine studies were identified as relevant to the topic and included in the analysis. The study was conducted through a review of research focusing on the relationship between posture and anatomical structures. Studies involving animals, research on posture in individuals with specific disorders, and studies that were repetitive were excluded from the analysis. Results: The studies reviewed examined different sample groups and addressed the relationship between posture and various anatomical structures. In the majority of these studies, it was found that posture has a direct relationship with numerous anatomical structures. Conclusion: The studies reviewed indicate that posture significantly affects anatomical structures, and this relationship is important from multiple perspectives in daily life. Therefore, this review aims to explore the relationship between posture and anatomical structures, clearly articulate this relationship, and emphasize its importance by conducting a comprehensive review of the relevant literature.

Intensity or Duration: That Is the Main Question of the Exercise Training Management in Stroke-Induced Neurological Deficit - A Systematic and Meta-analysis Study

Background: The neurological assessment plays a crucial role in evaluating stroke patients and is a skill that has been practiced by physicians for a long time, and further refined by practitioners. The purpose of the current study was to systematically review and synthesize the evidence-based neurological assessment of the different methods of treadmill-related training protocols in stroke patients. Evidence Acquisition: In this study, the appropriate studies were documented (N = 1270) using PubMed as the sole electronic database. Moreover, subgroup studies were provided based on training intensity and duration, categorized as low intensity-low duration, low intensity-high duration, high intensity-low duration, and high intensity-high duration. Training intensities were standardized to meters per second (m/s), and the training duration was calculated in terms of minutes per session, the number of sessions per week, and the total number of training weeks, which were then converted into minutes. The assessment of neurological recovery following stroke was conducted using standard neurological assessment scales. Results: This meta-analysis in humans found a notably positive standardized mean difference in protocols with high intensity and high duration (1.792; 95% CI = 0.566 to 3.02). Conclusions: In conclusion, the current meta-analysis suggests that practitioners using the high intensity-high duration protocol should regularly monitor the neurological outcomes, as they may be negatively impacted by the intensity and duration of the protocol.

CRISPR System and Its Applications in Medicine and Stem Cell Engineering

Context: The clustered regularly interspaced short palindromic repeat (CRISPR)/Cas system is a groundbreaking gene-editing tool that shows great promise for modifying genomes. Derived from prokaryotic adaptive immune defense mechanisms, this technique has been used in research on human diseases, demonstrating remarkable therapeutic potential. Through CRISPR, specific genetic mutations in patients can be corrected during gene therapy, offering a solution for treating diseases that were previously untreatable using conventional methods. This review explores the recent progress and future prospects of the CRISPR system, focusing on its applications in medicine and stem cell engineering. Special emphasis is placed on medical applications, the latest target design or analysis tools for genome editing, advancements in stem cell engineering, and associated innovations and challenges. Evidence Acquisition: This study reviewed articles indexed in ISI, SID, PubMed, and PubMed Central from 2007 to 2024. Results: Cas9, a key protein in CRISPR gene editing, is an endonuclease capable of targeting and cutting specific DNA sequences, guided by short RNA sequences. The gene editing process involves homology-directed repair (HDR), non-homologous end joining (NHEJ), and base editing pathways. Base editing, which modifies the epigenome without inducing DNA breaks, is gaining increasing attention. However, CRISPR still faces technical challenges, and the development of more efficient "super" CRISPR technology will likely require time. This article reviews the effectiveness, limitations, and applications of the CRISPR system. Conclusions: CRISPR/Cas9 tools allow for the creation of precise models, leading to more effective treatment options for patients.

Dipeptidyl Peptidase-4 Inhibitors: A Systematic Review of Structure-Activity Relationship Studies

Context: Dipeptidyl peptidase 4 (DPP-4) is a serine exopeptidase enzyme that hydrolyzes the amide bond at the N-terminal of peptides. This enzyme converts incretins, such as glucagon-like peptide I and glucose-dependent insulinotropic peptide, into their inactive forms, thereby preventing them from stimulating insulin secretion. Numerous studies have confirmed the role of DPP-4 in the pathophysiology of type 2 diabetes, leading to the development of various DPP-4 inhibitors. In recent years, research on DPP-4 inhibitors has expanded significantly, resulting in the creation of both non-peptidomimetic heterocyclic compounds and peptidomimetic scaffolds. Evidence Acquisition: This systematic review summarizes all recent advances related to DPP-4 inhibitors up to 2024. It begins by outlining the biochemical characteristics of DPP-4 and general pharmacological principles of DPP-4 inhibition, followed by an overview of the latest developments from recent publications. The review provides valuable insights into the pharmacophores necessary for ligand-protein interactions, aimed at understanding the structure-activity relationship of novel DPP-4 inhibitors. Data for this review was collected from sources including ScienceDirect, PubMed, and Scopus. Results: This review highlights various chemical scaffolds that have been explored in the development of novel DPP-4 inhibitors. It emphasizes scaffolds with significant DPP-4 inhibitory activity, including azoles, azines, sulfonamides, and quinolone motifs. The article also details the structure-activity relationships of newly developed analogs, providing a comprehensive overview of recent advancements in this area. Conclusions: Despite moderate progress in the development of novel DPP-4 inhibitors, emerging molecular aspects of DPP-4 intervention show great promise for future therapeutic developments.

Fish Species Spinal Cord Injury Models Utility for Research: A Systematic Review of Methodologies and Outcomes

Context: Spinal cord injury (SCI) is a devastating condition that results in severe disability and significant comorbidities. The complex pathophysiology of SCI repair and difficulties understanding neural regeneration are treatment challenges. Objectives: The aim of this study is to systematically review the diverse applications of various fish species as models for SCI research. Evidence Acquisition: PRISMA guidelines were used to review observational and interventional studies that utilized fish species as SCI models, published from inception to July 2023. Two independent reviewers screened and performed the data extraction. One independent reviewer assessed the risk of bias for the included studies. Results: Five thousand six hundred and thirty-three records were reviewed, and 144 met the inclusion criteria and were categorized by fish species. The majority of studies employed complete transection injuries, with the remainder being crush injuries, laser injuries, electro-ablations, and demyelination with substances. Zebrafish (Danio rerio) were most commonly utilized 102/144 (71%), primarily with larval models. Other models included Lamprey (Petromyzon marinus and Lethenteron reissneri); Goldfish (Carassius auratus); European eel (Anguilla Anguilla); Knifefish (Apteronotus leptorhynchus and Apteronotus albifrons); Sailfin Molly (Poecilia latipinna); and African turquoise killifish (Nothobranchius furzeri). Conclusions: This systematic review highlights that fish models, particularly zebrafish, goldfish, and European eels, are important models for further defining SCI pathophysiology and regenerative processes. These models provide a less complex model to gain insights into apoptosis and glial networks.

The Effectiveness of Acceptance and Commitment Therapy Method on the Life Expectancy of Patients with Various Diseases in Iran: A Literature Review Study

Context: Acceptance and commitment therapy (ACT) is a cognitive-behavioral psychotherapy method focusing on acceptance and commitment to life values. Objectives: This study aimed to evaluate the effectiveness of the ACT method on the life expectancy (LE) of patients with different diseases. Evidence Acquisition: The present study is a literature review that collects findings from past related studies in the last two decades. For this purpose, the essential and common Medical Subject Headings (MeSH) terms were first identified. Then, the desired MeSH terms were searched in the most reliable and essential international databases, including Google Scholar, Scopus, PubMed, Web of Science, and national databases, including Magiran, SID, Iran doc, etc. First, 265 articles were identified, and then 18 were selected as final studies considering the inclusion and exclusion criteria. Results: The findings of 18 studies were extracted for the present study. Some different types of patients, including those with rheumatoid arthritis, depression, multiple sclerosis, asthma, diabetes, liver transplants, chronic pain, cancer, physical-motor disabilities, drug addiction, and others, were shown to increase LE through the use of the ACT method. The main finding of the present study was that using the ACT method to increase LE in patients with various diseases has a significant effect, which was clearly highlighted in all the selected studies. Conclusions: Based on the findings, ACT is an effective and high-efficiency method in increasing patients' LE. Acceptance and commitment therapy can improve LE, resilience, quality of life, compliance with treatment, and other patient benefits, thus improving the speed of recovery for patients. Therefore, the ACT method, which is a non-pharmacological method, can be used by specialists and clinical psychology experts for different patients.

The Dietary Pattern Concerning Non-alcoholic Fatty Liver: An Umbrella Review and Meta-analyses of Observational Studies and Intervention Trials

Context: Non-alcoholic fatty liver disease (NAFLD) has been extensively studied in recent years, but the optimal dietary patterns for improving this condition remain unclear. Evidence Acquisition: Therefore, this umbrella review aimed to summarize the available evidence from meta-analyses on the relationship between various dietary patterns and NAFLD. Results: Two independent researchers identified published meta-analyses of interventional and observational studies that investigated the relationship between dietary patterns and NAFLD by searching electronic databases up until March 2023 and extracting relevant information. The pooled effect size of dietary patterns on NAFLD was evaluated using the standard mean difference (SMD) with a 95% confidence interval (CI). Fourteen meta-analyses met the inclusion criteria. Conclusions: All NAFLD-related outcomes, including hepatic steatosis, Fatty Liver Index (FLI), liver stiffness, and liver enzymes, were significantly affected by a calorie-restricted diet. Similarly, following the Mediterranean diet had beneficial effects on improving these outcomes. The findings support the role of a calorie-restricted diet and a Mediterranean diet in improving NAFLD, alongside the treatment protocol for these patients.

Stereotactic Body Radiotherapy (SBRT) for the Treatment of Primary Localized Renal Cell Carcinoma: A Systematic Review and Meta-Analysis

Context: Surgery is the gold standard for the local treatment of primary renal cell carcinoma (RCC), but alternatives are emerging. We conducted a systematic review and meta-analysis to assess the results of prospective studies using definitive stereotactic body radiotherapy (SBRT) to treat primary localised RCC. Evidence acquisition: This review was prospectively registered in PROSPERO (CRD42023447274). We searched PubMed, Embase, Scopus, and Google Scholar for reports of prospective studies published since 2003, describing the outcomes of SBRT for localised RCC. Meta-analyses were performed for local control (LC), overall survival (OS), and rates of adverse events (AEs) using generalised linear mixed models (GLMMs). Outcomes were presented as rates with corresponding 95% confidence intervals (95% CIs). Risk-of-bias was assessed using the ROBINS-I tool. Evidence synthesis: Of the 2983 records, 13 prospective studies (n = 308) were included in the meta-analysis. The median diameter of the irradiated tumours ranged between 1.9 and 5.5 cm in individual studies. Grade ≥ 3 AEs were reported in 15 patients, and their estimated rate was 0.03 (95%CI: 0.01–0.11; n = 291). One- and two-year LC rates were 0.98 (95%CI: 0.95–0.99; n = 293) and 0.97 (95%CI: 0.93–0.99; n = 253), while one- and two-year OS rates were 0.95 (95%CI: 0.88–0.98; n = 294) and 0.86 (95%CI: 0.77–0.91; n = 224). There was no statistically significant heterogeneity, and the estimations were consistent after excluding studies at a high risk of bias in a sensitivity analysis. Major limitations include a relatively short follow-up, inhomogeneous reporting of renal function deterioration, and a lack of prospective comparative evidence. Conclusions: The short-term results suggest that SBRT is a valuable treatment method for selected inoperable patients (or those who refuse surgery) with localised RCC associated with low rates of high-grade AEs and excellent LC. However, until the long-term data from randomised controlled trials are available, surgical management remains a standard of care in operable patients.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Urogynecological Surgery: A Systematic Review.

Background: Minimally invasive surgery could improve cosmetic outcomes and reduce the risks of surgical injury with less postoperative pain and a quicker patient's discharge. Recently, transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been introduced in urogynecology with exciting results. Evidence Acquisition: After PROSPERO registration (n°CRD42023406815), we performed a comprehensive literature search on Pubmed, Embase, and Cochrane CENTRAL, including peer-reviewed studies evaluating transvaginal natural orifice transluminal endoscopic surgery. No limits on time or type of study were applied. Evidence synthesis: Overall, 12 manuscripts were included in the analysis. Seven studies evaluated uterosacral ligament suspension, four studies evaluated sacral colpopexy, three evaluated sacrospinous ligament suspension, and one study evaluated lateral suspension. Overall success rates were high (>90%); however, definitions of success were heterogeneous. In terms of complication, most of the studies reported low-grade complications (Clavien-Dindo I and II); only two patients needed mesh removal because of mesh exposure. The risk of bias of the trials was rated in the medium to high-risk category. Conclusions: The present review highlights important initial results for vNOTES. Future randomized clinical trials are needed to better define its role in the management of urogynecological procedures.

A Literature Review Study on the Effectiveness of Pre-operative Education for Post-operative Pain Management

Context: Post-operative pain (POP) is one of the essential consequences of various surgeries in surgical patients, and various pharmacological and non-pharmacological methods should reduce it. Due to the side effects of medicinal methods, the use of non-medicinal methods has attracted the attention of nurses and health care workers nowadays. Considering this issue, the main goal of this study was to evaluate pre-operative education (POE) on the reduction of POP in surgical patients. Evidence Acquisition: This narrative review evaluated previous research from 1990 to 2024. Accordingly, 184 studies were obtained in the first search stage through advanced search in national and international databases, including Web of Science, Islamic World Science Citation Center (ISC), Scopus, PubMed, Magiran, and Google Scholar, Iran-Doc. Then, considering the inclusion and exclusion criteria, 22 studies were considered for the present review study. Results: Based on the present review, most evaluated studies (approximately 64%) showed that POE positively and significantly affects POP. Previous studies have reported that various parameters play a role in the impact of POE on POP, including the type of surgery, the length of follow-up, the continuity of care, the method of providing training, the quality of the intervention, the patient's awareness of the pain measurement method, with or without the educator's interaction and empathy during education, and the presence or absence of patient anxiety during training. Conclusions: Considering the positive and significant effect of POE on POP, nurses and caregivers of patients who are candidates for surgery should use the appropriate educational content and educational methods to reduce POP in patients according to the type of surgery and other influencing variables. However, before that, the nurses themselves should get enough information about the different methods of POE so that they can convey the educational content to the patients with proper quality and efficiency.

Association Between Exposure to Heavy Metals and Dyslexic Risk Among Children: A Narrative Review

Context: Developmental dyslexia (DD) is a learning disorder characterized by difficulties in reading due to challenges in sound identification and letter-word association. This study aimed to evaluate the correlation between exposure to heavy metals (HMs) and the risk of dyslexia in children through a narrative review. Evidence Acquisition: The study adopted a narrative review approach, utilizing keywords to search reputable databases like Google Scholar, Scopus, PubMed, and Web of Science. Relevant research meeting specific criteria were selected for analysis. Results: In most studies, metals were measured in children's urine. The results indicated that children with DD had lower levels of essential metals such as zinc (Zn), selenium (Se), and cobalt (Co). In contrast, toxic metals like mercury (Hg), cadmium (Cd), silver (Ag), and lead (Pb) were significantly higher compared to the control group. Based on the results of previous studies, no significant variations were observed in other essential and toxic metals between the case and control groups. Conclusions: Essential metals like Zn, Se, and Co may protect against DD in children, whereas toxic metals such as Pb, Ag, Cd, and Hg could exacerbate the disorder. It is recommended to evaluate essential and toxic metal levels in parents before and during pregnancy and in infants to mitigate dyslexia risk in children.

Luteal Phase Defects and Progesterone Supplementation

Importance: Luteal phase defects (LPDs), or an insufficiency of progesterone production during the luteal phase of the menstrual cycle, have been identified as a potential cause of recurrent pregnancy loss (RPL), but its exact contribution to RPL is not well-defined. In addition, the role of exogenous progesterone supplementation during pregnancy remains controversial. Objective: The goal of this review is to provide an updated, evidence-based summary of LPD, including prevalence and potential pathophysiologic mechanisms, and to explore the current controversies regarding progesterone supplementation for management and treatment of RPL. Evidence Acquisition: A literature review identified relevant research using a PubMed search, Cochrane summaries, review articles, textbook chapters, databases, and society guidelines. Results: Endogenous progesterone plays a crucial role in the first trimester of pregnancy, and therefore, insufficiency may contribute to RPL. However, the precise relationship between LPD and RPL remains unclear. LPD is primarily a clinical diagnosis based on a luteal phase less than 10 days. Although there may be a possibility of incorporating a combined clinical and biochemical approach in defining LPD, the current lack of validated diagnostic criteria creates a challenge for its routine incorporation in the workup of infertility. Moreover, no treatment modality has demonstrated efficacy in improving fertility outcomes for LPD patients, including progesterone supplementation, whose inconsistent data do not sufficiently support its routine use, despite its minimal risk. It is imperative that women diagnosed with LPD should be worked up for other potential conditions that may contribute to a shortened luteal phase. Future work needs to focus on identifying a reproducible diagnostic test for LPD to guide treatment. Conclusions and Relevance: Currently, the perceived relationship between LPD and RPL is challenged by conflicting data. Therefore, patients with an abnormal luteal phase should undergo a thorough workup to address any other potential etiologies. Although supplemental progesterone is commonly used for treatment of LPD and RPL, inconsistent supporting data call for exogenous hormone therapy to be only used in a research setting or after a thorough discussion of its shortcomings.

Diagnostic Performance of MRI and FDG PET/CT for Preoperative Locoregional Staging of Colon Cancer: Systematic Review and Meta-Analysis.

Background: CT is the standard-of-care test for colon cancer (CC) preoperative locoregional staging, but has limited diagnostic performance. More accurate preoperative staging would guide selection among expanding patient-tailored treatment options. Objective: To evaluate the diagnostic performance of MRI for T and N staging and of FDG PET/CT for N staging in CC locoregional staging through systematic review. Evidence Acquisition: PubMed, Embase, and Cochrane Library were searched through December 31, 2023 for studies reporting diagnostic performance of MRI or FDG PET/CT for primary (nonrectal) CC before resection without neoadjuvant therapy using histopathology as reference. Study quality was assessed using the QUADAS-2 tool. Publication bias was assessed with Deeks' funnel plot. Primary outcomes were estimated pooled predictive values, stratified by T and N categories for MRI and N categories for PET/CT. Secondary outcomes were pooled sensitivity and specificity. Evidence Synthesis: The systematic review included 11 MRI studies (686 patients) and five PET/CT studies (408 patients). Thirteen studies had at least one risk of bias or concern of applicability. Deeks' funnel plot asymmetry indicated possible publication bias in MRI studies for differentiation of T3cd-4 from T1-3ab disease and N- from N+ disease. For MRI, for discriminating T1-2 from T3-4 disease, PPV was 64.8% (95% CI [52.9-75.5%]), and NPV was 88.9% (95% CI [82.7-93.7%]); for discriminating T1-3ab from T3cd-4 disease, PPV was 83.4% (95% CI [75.0-90.3%]), and NPV was 74.6% (95% CI [58.2-86.7%]); for discriminating T1-3 from T4 disease, PPV was 94.0% (95% CI [89.4-97.3%]), and NPV was 39.9% (95% CI [24.9-56.6%]); for discriminating N- from N+ disease, PPV was 74.9% (95% CI [69.3-80.0%]), and NPV was 53.9% (95% CI [45.3-62.0%]). For PET/CT, for discriminating N- from N+ disease, PPV was 76.4% (95% CI [67.9-85.1%]), and NPV was 68.2% (95% CI [56.8-78.6%]). Across outcomes, MRI and PET/CT exhibited pooled sensitivity of 55.1-81.4% and pooled specificity of 70.3-88.1%. Conclusion: MRI had strongest predictive performance for T1-2 and T4 disease. MRI and PET/CT had otherwise limited predictive values, sensitivity, and specificity for evaluated outcomes related T and N staging. Clinical Impact: MRI and FDG PET/CT had overall limited utility for preoperative locoregional staging in colon cancer.

Recent advancements in novel formulations of anti-psoriatic agents for effective delivery: clinical importance and patent survey.

Objectives An autoimmune-mediated dermatological ailment featuring recurrent episodes is acknowledged as psoriasis. Around the world, 2-3% of people suffer from this autoimmune skin condition. The primary goal of the current review is to analyse and determine the effectiveness of conventional and emerging nano technological strategies to alleviate psoriasis and discuss future perspectives. Evidence acquisition A thorough search of numerous electronic databases, including Science Direct, Scopus, Google Scholar, Clinical Trials, Google Patents, Research Gate, and PubMed, yielded all the data used in this review paper about the management of psoriasis via various anti-psoriatic agent and nanotechnology approaches. Keywords such as topical, liposomes, niosomes, micro needles, clinical trials, patents, pathogenesis, biosimilars, cytokines, and other pertinent words were investigated. Results Nano technological approaches are gaining prominence since they enable targeted delivery, rapid onset of action with limited systemic exposure. Researchers have investigated innovative, alternative therapeutic approaches that are both secure and efficient for treating psoriatic conditions. Further, the potential role of numerous psoriatic conventional therapies has been explored. The patents granted or in process to address psoriasis via topical route have been well explored. Modern nanotechnology has made it possible for pharmaceuticals to be delivered with improved physical, chemical, pharmacokinetic, and pharmacodynamic qualities. Despite extensive research complete cure for psoriasis is hampered. Conclusion Relying on the extensive literature review, it can be inferred that nanoparticles based novel delivery strategies have the possibility of enhancing the pharmacological activity and eliminating or resolving problems associated with this ailment. The different drug delivery systems available for the treatment of psoriasis along with the clinical trials in different stages, patents in process and granted, the commercialized status of therapeutic molecules, and the future of research in this area have been thoroughly reviewed.

The Interplay of Microbiota, Long COVID, and Musculoskeletal Pain: A Narrative Review

Context: Long COVID, a condition that persists after the acute phase of COVID-19, poses a significant burden, with 10 - 45% of recovered patients experiencing persistent symptoms. Among these, approximately 46% report musculoskeletal pain. This narrative review explores the potential connections between gut microbiota, Long COVID, and musculoskeletal pain, aiming to introduce new therapeutic avenues and preventive strategies for managing musculoskeletal symptoms in Long COVID patients. Evidence Acquisition: A comprehensive search was conducted using Google Scholar, Lens.org, and ConnectedPaper.com to identify relevant articles published between 2019 and 2024. Keywords related to microbiota, Long COVID, and musculoskeletal pain were used. Articles were selected based on predefined inclusion and exclusion criteria, and their quality was assessed. Data from the selected articles were synthesized to provide an overview of the interplay between microbiota, Long COVID, and musculoskeletal pain. Results: Recent research highlights the significant role of gut microbiota in modulating immune responses and systemic inflammation. Dysbiosis has been linked to the severity and progression of COVID-19 and the persistence of Long COVID symptoms. Individuals with Long COVID often experience new-onset musculoskeletal manifestations, such as joint pain, myalgia, and chronic musculoskeletal pain. Additionally, gut dysbiosis has been associated with conditions like lower back pain and knee osteoarthritis. This suggests that the relationship between gut dysbiosis and musculoskeletal problems in general may also extend to musculoskeletal pain in Long COVID patients, indicating broader implications for musculoskeletal outcomes. Therapeutic strategies targeting the gut microbiota, such as probiotics, prebiotics, and dietary interventions, have shown promise in managing these symptoms and improving overall health outcomes. Conclusions: The evidence underscores the importance of understanding the microbiota-musculoskeletal nexus in Long COVID. Gut dysbiosis contributes to systemic inflammation, exacerbating musculoskeletal symptoms in Long COVID patients. The associations between gut dysbiosis and other musculoskeletal conditions emphasize the need for microbiota-targeted therapeutic strategies. Future research should focus on elucidating the mechanisms linking gut dysbiosis to musculoskeletal pain, exploring the gut-brain axis, and developing personalized approaches to modulate the microbiota. Advancing our understanding of this nexus can pave the way for innovative therapeutic strategies to address the complex health challenges posed by Long COVID and other musculoskeletal conditions.