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Understanding Medical trial Studies: Getting rid of Health-related Organizations as well as their Associations.
8; among these articles, the most frequently cited article received 5515 citations, and the least frequently cited article received 1155 citations. In total, 60 were original articles among the 100 most-cited articles. The most frequently represented specialties were hepatitis, hepatocellular carcinoma, and nonalcoholic fatty liver disease, which accounted for 53.3%, 23.3%, and 11.7% of these articles, respectively. DISCUSSION Our study identified citation classics and provided a review of the most advanced studies in the field of hepatology. This can help to guide clinical treatment and future academic research resulting in advancements in hepatology. CDH1 mutation is the most frequent genetic alteration in hereditary diffuse gastric cancer (GC) and early onset diffuse GC patients. However, the incidence of CDH1 mutations in sporadic GC with or without family history has not been studied. This retrospective study includes a total of 993 Korean patients with primary advanced GC who underwent surgery and received palliative chemotherapy. Targeted deep sequencing was performed in all cases and family history of GC was searched with survival analysis. We found CDH1 alterations in 146 of 993 patients (14.7 %) and 8 were germline (0.8 %). Out of 146 patients with CDH1 mutations, 25 (17.1 %) had a family history of GC in one of their first relatives, and 12 patients (8.2 %) were diagnosed with familial GC (FGC). All cases with FGC were diffuse type by Lauren classification, and only one harbored a previously reported germline mutation of CDH1 (c.2638 G > A) and the remaining 11 harbored known somatic CDH1 mutations. Among all patients with CDH1 mutation, there was no significant survival difference between patients with family history or FGC. Cepharanthine In the 847 patients without CDH1 mutation, 189 (22.3 %) had a family history of GC and 92 patients (10.9 %) were FGC. CDH1 mutations were more frequent in patients with early onset ( 0.05). CDH1 mutations are mostly somatic and typically are not associated with family history. Tailoring of breast cancer treatment to the individual has especially occurred in breast cancer surgery paradigms have changed from Halsted's radical mastectomy in 1882, to simple mastectomy, to lumpectomy. Within the next decade, we might face another paradigm change of omitting breast cancer surgery at all in case of a complete response after neoadjuvant systemic treatment. In this article, we provide an overview of the reasoning for this new paradigm change, the criticism it has evoked, and under which conditions it might be incorporated into clinical practice. We also take a look at previous paradigm changes in breast cancer surgery and the insights they provide us in the current situation on a statistical but also on a psychological level. Screening plays an important role in women with a high risk of breast cancer. Given this population's high incidence of breast cancer and younger age of onset compared to the general population, it is recommended that screening starts earlier. There is ample evidence that magnetic resonance imaging (MRI) is the most sensitive diagnostic tool, and American and the European guidelines both recommend annual MRI screening (with supplementary annual mammography) as the optimum screening modality. Nevertheless, the current guidelines do not totally agree about the recommendations for MRI screening in some subgroups of patients. The first part of this article on screening in women with increased risk of breast cancer reviews the literature to explain and evaluate the advantages of MRI screening compared to screening with mammography alone increased detection of smaller cancers with less associated lymph node involvement and a reduction in the rate of interval cancers, which can have an impact on survival and mortality (with comparable effects to other preventative measures). At the same time, however, we would like to reflect on the drawbacks of MRI screening that affect its applicability. The aim of the study described here was to determine whether vascularity patterns on Doppler ultrasonography (US) differentiate benign and malignant thyroid nodules with the intermediate suspicion pattern based on the 2015 American Thyroid Association guidelines. A total of 411 benign or malignant thyroid nodules from 406 patients with intermediate-suspicion US features were retrospectively collected. Univariate and multivariate logistic regression analyses with the generalized estimating equation were used to identify factors predicting malignancy, and odds ratios with 95% confidence intervals were calculated. The vascularity patterns significantly differed between the benign (353 of 411, 85.9%) and malignant (58 of 411, 14.1%) nodules (p = 0.005). Only intranodular vascularity was significantly associated with malignancy on univariate analysis (p = 0.006) and was an independent predictor of malignancy on multivariate analysis (p = 0.004). In conclusion, intranodular vascularity on Doppler US may be useful for predicting malignancy in thyroid nodules with the intermediate-suspicion pattern. INTRODUCTION Bromelain-based Enzymatic Debridement has been introduced as an additional concept to the burn surgeon's armamentarium and is best indicated for mid-to deep dermal burns with mixed patterns. Increasing evidence has been published focusing on special regions and settings as well as on limitations of Enzymatic Debridement to improve patient care. To better guide Enzymatic Debridement in view of the increasing experience, there is a need to update the formerly published consensus guidelines with user-orientated recommendations, which were last produced in 2017. METHODS A multi-professional expert panel of plastic surgeons and burn care specialists from twelve European centers was convened, to assist in developing current recommendations for best practices with use of Enzymatic Debridement. Consensus statements were based on peer-reviewed publications and clinical relevance, and topics for re-evaluation and refinement were derived from the formerly published European guidelines. For consensus agreemef application for Enzymatic Debridement was introduced, discriminating immediate/very early (≤12 h), early (12-72 h) or delayed (>72 h) treatment. All further recommendations are addressed in the publication. CONCLUSIONS The updated guidelines in this publication represent further refinement of the recommended indication, application and post-interventional management for the use of ED. The published statements contain detailed, user-orientated recommendations aiming to align current and future users and prevent pitfalls, e.g. for the successful implementation of ED in further countries like the USA. The significance of this work is reflected by the magnitude of patient experience behind it, larger than the total number of patients treated in all published ED clinical trials. Measles is a contagious viral infection that usually affects children. The disease is caused by morbillivirus, a virus of the family Paramyxoviridae. The clinical picture is characterized by four phases incubation, invasion, eruption and desquamation. Ophthalmologic manifestations in measles are rare, dominated by conjunctivitis and keratitis. Corneal involvement is the main concern; it varies from simple superficial punctate keratitis to corneal perforation. We report three cases of acute keratitis in young adults during an epidemic. The epithelial involvement was peripheral, central or diffuse. The outcome was favorable under symptomatic topical treatment. BACKGROUND Globally, attitudes and practices towards toilet training have changed several decades ago and children are completing toilet training at a later age compared to previous generations. Concurrently, there has been an increase in the incidence of pediatric bladder bowel dysfunction (BBD), including lower urinary tract dysfunction (LUTD). Whether the fact of delayed toilet training may negatively impact the ability of children to obtain bladder and bowel control and cause LUT dysfunction remains controversial. OBJECTIVES To investigate the association between age at initiation of toilet training or approach to toilet training and the risks of lower urinary tract (LUT) dysfunction. METHODS A comprehensive search of the CENTRAL, EMBASE and MEDLINE via Ovid SP, and CINAHL via EBSCO databases was conducted to identify RCTs, cohort or case-control studies investigating the association between age at initiation of toilet training, approach used for toilet training, and pediatric LUT dysfunction. RESULTS A tly in studies, findings from the current study suggested that the optimal time for initiating toilet training may be prior to the age of 24 months; if toilet training was initiated after 24 months or later, it may result in increased prevalence of LUT dysfunction. Since no RCTs studies were included in the current meta-analysis, well-designed longitudinal studies with larger sample size and from different cultural background are needed to confirm these results. CONCLUSION This meta-analysis presents preliminary findings that show the incidence of LUTD may be decreased by initiating toilet training in children at a younger age. Despite a high incidence of hematologic malignancies in older adults, available data indicate that there is disproportionately low representation of adults ≥65 years with hematologic malignancies (greater in patients ≥75 years) in clinical trials. Biological and clinical differences between older and younger adults and diversity within older patients necessitate adequate representation of the older subpopulation in hematologic malignancy trials. This would allow trial results to be generalizable and inform treatment decisions in the older patient population. Restrictive eligibility criteria may be barriers to adequate representation, as older adults do not typically meet these criteria. Efforts to broaden eligibility criteria in clinical trials have been proposed and may promote enrollment of a representative older population with hematologic malignancies. Collaboration among a diverse group of stakeholders will be needed to implement current proposals and evaluate their impact on increasing representation of older adults in trials evaluating therapies for hematologic malignancies. Moraxella keratitis can lead to important complications. Moraxella nonliquefaciens(M. nonliquefaciens) has the worst prognosis. Only three cases of corneal infections due to M. nonliquefaciens have been published. The case presented is of a 79-year-old man with bullous keratopathy, recently affected with severe infectious keratitis. Dense, deep, and central stromal infiltrates and hyphaema were detected. After the identification of M. nonliquefaciens in the culture, and given the progression of the condition, the initial empirical treatment was modified to topical ciprofloxacin and ceftazidime in accordance with the antibiogram, combining oral ciprofloxacin and amoxicillin-clavulanate. After 27 days, there was total resolution of the lesion, with central residual leucoma. Keratitis caused by M. nonliquefaciens is rare and must be suspected in elderly patients with local predisposing factors, such as corneal damage or previous eye surgery. Early antibiogram-guided treatment and close monitoring are important to avoid complications and poor compliance.
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