Evolution of Surgical Treatment of Metastatic Spine Tumors.

Purpose The treatment of cancer has transformed over the past forty years, with medical oncologists, radiation oncologists and surgeons working together to prolong survival times and minimize treatment related morbidity. With each advancement, the risk-benefit scale has been calibrated to provide an accurate assessment of surgical hazard. The goal of this review is to look back at how the role of surgery has evolved with each new medical advance, and to explore the role of surgeons in the future of cancer care. Methods A literature review was conducted, highlighting the key papers guiding surgical management of spinal metastatic lesions. Conclusion The roles of surgery, medical therapy and radiation have evolved over the past forty years, with new advances requiring complex multidisciplinary care.

Cardiac Resynchronization Therapy (CRT) with or without Defibrillation in Patients with Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-analysis

Background - Cardiac resynchronization therapy (CRT) represents a major medical advance in patients with heart failure (HF) with electrical dysschrony to improve symptoms, reduce hospitalization, and increase survival both in the presence and absence of implantable-cardioverter defibrillator (ICD) therapy. However, among CRT-eligible patients with non-ischemic cardiomyopathy (NICM), the benefit of defibrillator therapy in addition to CRT remains unclear. A systematic review and meta-analysis comparing outcomes of patients with NICM and HF who underwent CRT with ICD (CRT-D) vs. CRT only (CRT-P) was therefore performed. Methods - A literature search from inception through February 2020 was conducted in PubMed and Cochrane Review Databases for all studies reporting outcomes of CRT-D versus CRT-P in CRT-eligible patients with NICM. Studies reporting non-stratified outcomes including patients with ischemic cardiomyopathy were excluded. The primary end point of interest was all-cause mortality. A random effects model using hazards ratio (HR) was utilized to calculate a cumulative HR for all-cause mortality. The GRADE approach assessed the certainty of evidence across outcomes. Results - Of a total of 1,478 potential citations, the search yielded eight citations that met inclusion and exclusion criteria. There was one randomized controlled trial which included a sub-group of 645 CRT-eligible NICM patients (322 with CRT-D and 323 with CRT-P). Seven observational studies representing 9,944 CRT-eligible patients with NICM (6,865 CRT-D implantation and 3,079 with CRT-P) were included in a pooled meta-analysis. The cumulative adjusted HR for all-cause mortality for CRT-D versus CRT-P was 0.92 (95% CI; 0.83, 1.03); I 2 = 0 though with low certainty of evidence. There may be little difference in infection and cardiac mortality between CRT-D versus CRT-P devices (HR: 0.82; 95% CI: 0.29, 2.20 moderate certainty of evidence, and HR: 0.68; 95% CI: 0.37, 1.25, low certainty of evidence, respectively). Conclusions - In this meta-analysis, the addition of defibrillator therapy was not significantly associated with a reduction in all-cause mortality in CRT-eligible patients with NICM.

Translational science in chronic tendinopathies

<p>Chronic tendinopathies involve majority of patients in clinical practice of orthopaedic surgeons and sports physicians. Translational medicine confers an emerging medical advance efficiently towards the clinician directly from scientists which may be used as a targeted therapy. The main objective of translational research from “bench to bedside” is to test novel inventions in humans. Our purpose in this article to understand the translational medicine approach for chronic tendinopathies in clinical aspects. Translational research in chronic tendinopathies is required certainly due to plenty of reasons. Newer advances and targeted approach to these tendon disorders may curtail the further degenerative process. It aids in earlier diagnosis and prevention of morbidity, early occupancy of occupational activity, lack of economical as well as recreational failure. Pre-disease level activity is ultimate goal of any therapy. Tendon pathophysiology is constantly evolving researched topic in both biochemical as well as molecular aspect. The basic fundamental understanding of complex process of tendon healing and regeneration is necessary for formulating a newer guideline. The cornerstone of treatment of tendinopathies is still non-operative management. Physical therapy, better pain control, NSAIDS are still primary choice for these conditions. Various biological therapy whenever used one should combined them with other appropriate options to obtain an optimum outcome.</p>

Antibacterial power of Olea Europaea extracts from different Moroccan regions

The discovery of antibiotics has always been a medical advance that has improved the prognosis of infections. However, resistance to these products has evolved into a major health problem. Some diseases are even resistant to all antibiotics currently available on the market. A reduction in the use of antibiotics must be based on other approaches, namely the use of alternative treatments to antibiotics, such as phytotherapy. In the same objective our study focused on the research of the antibacterial power of Olea Europaea known for its various medicinal properties. 31 bacterial strains were tested for their susceptibility using the agar diffusion method, and we determined their MIC by the micro titration technique on microplates. Five bacteria belonged to the American collection (ATCC) and 26 strains isolated from nosocomial infections between the period of 2011 and 2015. We noticed that our aqueous, methanolic, ethanolic and ethyl acetate extracts are active against all tested bacteria. On the other hand, we observed that the hexane and dichloromethane extracts showed no inhibition effect on all the bacteria tested. The methanolic extract showed a higher MIC against ESBL enterobacteria (E. coli, E. cloacae, P. mirabilis) and imipenem-resistant A. baumanii. The lowest MIC was 1.56 ug / ml.

Pyruvate Research and Clinical Application Outlooks A Revolutionary Medical Advance

Pyruvate holds superior biomedical properties in increase of hypoxia tolerance, correction of severe acidosis, exertion of anti-oxidative stress and protection of mitochondria against apoptosis, so that it improves multi-organ function in various pathogenic insults. Particularly, pyruvate preserves key enzyme: pyruvate dehydrogenase (PDH) activity through direct inhibition of pyruvate dehydrogenase kinas (PDK), as a PDH activator, in hypoxia. Therefore, pyruvate is robustly beneficial for cell/organ function over citrate, acetate, lactate, bicarbonate and chloride as anions in current medical fluids. Pyruvate-enriched oral rehydration salt/solution (Pyr-ORS) and pyruvate-based intravenous (IV) fluids would be more beneficial than WHO-ORS and current IV fluids in both crystalloids and colloids, respectively. Pyruvate-containing fluids as the new generation would be not only a volume expander, but also a therapeutic agent simultaneously in fluid resuscitation in critical care patients. Pyruvate may be also beneficial in prevent and treatment of diabetes, aging and even cancer. Pyruvate clinical applications indicates a new revolutionary medical advance, following the WHO-ORS prevalence, this century.

Statins Stimulate Hepatic Glucose Production via the miR-183/96/182 Cluster

Statins are the most common pharmacologic intervention in hypercholesterolemic patients, and their use is recognized as a key medical advance leading to a 50% decrease in deaths from heart attack or stroke over the past 30 years. The atheroprotective outcomes of statins are largely attributable to the accelerated hepatic clearance of low-density lipoprotein (LDL)-cholesterol from circulation, following the induction of the LDL receptor. However, multiple studies suggest that these drugs exert additional LDL–independent effects. The molecular mechanisms behind these so-called pleiotropic effects of statins, either beneficial or undesired, remain largely unknown. Here we determined the coding transcriptome, miRNome, and RISCome of livers from mice dosed with saline or atorvastatin to define a novel in vivo epitranscriptional regulatory pathway that links statins to hepatic gluconeogenesis, via the SREBP2–miR-183/96/182–TCF7L2 axis. Notably, multiple genome-wide association studies identified TCF7L2 (transcription factor 7 like 2) as a candidate gene for type 2 diabetes, independent of ethnicity. Conclusion: our data reveal an unexpected link between cholesterol and glucose metabolism, provides a mechanistic explanation to the elevated risk of diabetes recently observed in patients taking statins, and identifies the miR-183/96/182 cluster as an attractive pharmacological candidate to modulate non-canonical effects of statins.

A survey of cancer patients’ rehabilitation therapy needs in Southwest China.

e18003 Background: Medical advance in the recent decades has turned cancer into a chronic disease. At the same time, quality of life (LoF) during the treatment period has emerged as a new concern of cancer patients. Rehabilitation therapy, which can help patients conquer fear and be more engaged in the process, has gradually attracted more attentions in China. We designed a survey, for both the cancer patients and their families, to understand their view of the rehabilitation therapy. Methods: We sent paper-based surveys to volunteers consisted of cancer patients and their families. Majority of patients are from 10 cancer centers at the southwest region of China. The main cancer types are lung cancer, breast cancer and colon cancer. The survey questions focus on: patients and their families’ engagement of the treatment, their view on rehabilitation therapy, and their method preference for the rehabilitation therapy. Results: We sent 2,000 copies of the survey and received 1,920 valid inputs. Below are the key findings. 1. Their biggest concern: the outcome of the treatment 55.8%, side effects 19.7%, financial burden 12.8% and mental stress 11.5%. 2. The importance of the rehabilitation therapy as compared to traditional medical treatment, such as surgery and chemotherapy: equally important 67.8%, less important 17.7%, more important 10.1%, no preference 4.4%. 3. The necessity of rehabilitation therapy: very necessary 65.7%, somewhat necessary 22.7%, not necessary 11.6%. 4. The first three reasons for participating rehabilitation therapy: it helped go through the treatment 42.8%, it improved quality of life 31.6% and it helped release their mental stress 22.3%. 5. The best form to conduct rehabilitation therapy: face-to-face communicate with the doctors 60.6%, telecommunication 15.8% and combination of both 22.1%. Conclusions: The results of the survey strongly indicate the demands for rehabilitation therapy. Patients started to understand it – more than half of them think it is as important as the traditional medical treatment. Patients’ quality of life and mental health, which is part of the holistic treatment, are gradually recognized. Next, we plan to group our survey results by types of cancers, patients and their families’ genders and age, as well as the local economics, to better understand the data. We hope this study can serve as a data point to help build China’s rehabilitation therapy infrastructure.