Emergency Medicine Resident | Researcher
Published author of 32 research papers with expertise in advanced data analysis, systematic reviews, and meta-analysis.
Background: Routinely collected health data are increasingly used in clinical research. No study has systematically reviewed the temporal trends in the number of publications and analyzed different aspects of local research practices and their variations in Hong Kong, China, with a specific focus on research ethics governance and approval. Methods: PubMed was systematically searched from its inception to March 28, 2023, for studies using routinely collected healthcare data from Hong Kong. Results: A total of 454 studies were included. Between 2000 and 2009, 32 studies were identified. The number of publications increased from 5 to 120 between 2010 and 2022. Of the investigator-led studies using the Hospital Authority (HA)’s cross-cluster data (n = 393), 327 (83.2%) reported receiving ethics approval from a single cluster/university-based REC, whereas 50 studies (12.7%) did not report approval from a REC. For use of the HA Data Collaboration Lab, approval by a single hospital-based or University-based REC is accepted. Repeated submission of identical ethics applications to different RECs is estimated to cost HK$4.2 million yearly. Conclusions: Most studies reported gaining approval from a single cluster REC before retrieval of cross-cluster HA data. Substantial cost savings would result if repeated review of identical ethics applications were not required.
The recent outbreak of monkeypox has presented challenges to healthcare systems. Therefore, a coordinated approach involving healthcare providers, government organizations, and the public is crucial in controlling the monkeypox outbreak. Further research is necessary to understand the virus and develop effective interventions for future outbreaks.
Brain metastasis in gastric cancer (GC) patients is a rare phenomenon that is associated with adverse clinical outcomes and poor survival rates. We conducted a retrospective cohort study to investigate the incidence, risk factors and prognostic factors of brain metastasis in GC patients. Data on sociodemographic and tumor characteristics of GC patients from 2010 to 2019 was extracted from the Surveillance, Epidemiology and End-Results (SEER) database. Descriptive statistics, multivariable logistic and Cox regression were applied on SPSS. Kaplan-Meier-Survival curves and ROC curves were constructed. A total of 59,231 GC patients, aged 66.65 ± 13.410 years were included. Brain metastasis was reported in 368 (0.62%) patients. On logistic regression, the risk of brain metastasis was significantly greater in males, patients aged < 60 years and patients having concurrent bone and lung metastasis. High grade and high N stage were significant risk factors for development of brain metastasis. Patients who had undergone surgery for the primary tumor were at reduced risk for brain metastasis (adjusted odds ratio 0.210, 95% CI 0.131-0.337). The median OS was 3 months in patients with brain metastasis and 17 months in patients without brain metastasis (p < 0.05). On Cox regression, Grade IV tumors and primary antral tumors were significant predictable parameters for poor prognosis. Overall Survival (OS) and Cancer-Specific Survival (CSS) were prolonged in patients who had undergone surgery. Brain metastasis in gastric cancer is associated with significantly worse survival. Employing large-scale screening for high-risk patients holds a promising impact to improve survival rates, but it must be accurately balanced with a comprehensive understanding of clinicopathological aspects for accurate diagnosis and treatment.
Informed consent is a fundamental element of clinical practice. A well-structured and understandable consent form not only upholds patients' rights but also protects clinicians against medicolegal risks. This quality improvement project aimed to identify deficiencies in the consenting process for surgical procedures and implement changes to enhance patient care. The project was conducted in the Ear Nose Throat Department at Holy Family Hospital, Rawalpindi, a large tertiary care centre serving a predominantly low socioeconomic population in Pakistan. A total of 80 patients were included across two cycles (40 patients per cycle). Structured interviews and questionnaires were used to assess patient understanding of informed consent components. Key areas for improvement were identified. Educational sessions for doctors were organised and a new, detailed consent form was introduced. The project followed the Plan-Do-Study-Act methodology. Baseline measurements in cycle 1 showed that 15% (n=6) of consent forms were incomplete, reduced to 0% postintervention. A written explanation of the procedure was missing in 57.5% (n=23) of cases initially, improving to 10% (n=4) in cycle 2. Potential complications were not recorded in 37.5% (n=15) of cases at baseline, falling to 10% (n=4) after intervention. Verbal explanation of the procedure was omitted in 32.5% (n=13) of cases initially, reduced to 5% (n=2) postintervention. Documentation of the right to withdraw was absent in 12.5% (n=5) of cases in cycle 1, with full compliance achieved in cycle 2. This project demonstrates that targeted educational interventions and structured consent documentation can significantly improve the quality of the consenting process, promoting safer and more patient-centred care.
Our findings indicate that PCH does not exert a substantial impact on the survival of brain cancer patients, except in cases involving gastrointestinal or hematologic and lymphatic PCH, or when the brain cancer is glioblastoma.
Waldenström macroglobulinemia (WM) is a rare lymphoplasmacytic lymphoma which may predispose individuals to development of secondary malignancies (SMs). The Surveillance, Epidemiology, and End Results (SEER) database is a comprehensive registry of cancer patients in the United States reporting on a wide set of demographic variables. Using the SEER-18 dataset, analyzing patients from 2000 to 2018, we aimed to assess the incidence of SMs in WM patients. Patient characteristics such as gender, age, race, and latency were identified, and respective standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated to compare to the general population. Of the 4,112 eligible WM patients identified, SMs were reported in 699 (17%) patients. The overall risk of developing SM, second primary malignancy, and secondary hematological malignancy was significantly higher in WM patients compared to the general population. Our findings show that WM patients had a 53% higher risk of SMs relative to the general population, and an AER of 102.69 per 10,000. Although the exact mechanism is unclear, the risk of SM development may be due to genetic predisposition, immune dysregulation, or treatment-induced immune suppression.
INTRODUCTION: Waldenström Macroglobulinemia (WM), is a hyper-viscosity syndrome characterized by unrestricted proliferation of lymphoplasmacytic precursors in the bone marrow and monoclonal IgM gammopathy. The development of secondary primary malignancy (SPMs) in WM is a multifactorial phenomenon; the indolent nature of the disease, associated immune dysregulation, environmental factors and therapeutic measures, are responsible for high incidence of SPM in WM. This study was conducted to analyse the site-specific incidence of SPM in WM using data from the US Surveillance, Epidemiology and End Results (SEER) cancer registries. METHODS: A retrospective study was conducted using the SEER-18 dataset. WM patients who were diagnosed between 2000 and 2018, according to the ICD-O-3 = 9761/3 were included. Patients diagnosed on autopsy or through death certificates, and patients with incomplete follow-up data were excluded. SPM was defined as other malignancy appearing at least 1 year after WM diagnosis. Latency was defined as interval between WM and SPM diagnosis. Standardized incidence ratios (SIRs) and absolute excess risks (AERs) were calculated using SEER*Stat software (version 8.3.9). P-values and 95% confidence intervals (CI) were generated assuming Poisson distribution of observed incidence of SPM. RESULTS: A total of 4112 WM patients were identified. SPM was reported in 699 (17.0%) patients. The overall risk of developing SPM was significantly higher in WM patients as compared to the general population (SIR= 1.53, 95% CI=1.42-1.65, p <0.05) with an AER of 102.69 per 10,000 population. The risk of developing second primary solid tumors was significantly greater compared to the general population (SIR = 1.12, 95% CI= 1.02-1.23, p >0.05), but significantly increased risks were reported for secondary tumours of the lung and bronchus (SIR = 1.44), skin melanoma (SIR = 1.88), mouth (SIR 3.28), brain (SIR 2.73) and non-melanotic skin tumors (SIR = 4.09). The overall risk of developing secondary hematological malignancies was significantly increased (SIR = 4.95, 95% CI 4.31-5.66, p <0.05). Significantly increased risks were reported for nodal non-Hodgkin lymphoma (NHL) (SIR = 6.62), extranodal NHL (SIR = 11.3), acute lymphocytic leukemia (ALL) (SIR 8.04), acute non-lymphocytic leukemia (ANLL) (SIR = 4.2) and acute myeloid leukemia (AML) (SIR 4.22). Increased risk of SPMs was noted for patients with age 50-74 years (SIR= 1.65, 95%CI=1.44-1.89, p value <0.05) or > 75 years (SIR= 1.3, 95% CI= 1.13-1.49, p value <0.05), but not for patients younger than 50 years. Patients aged 50-74 years had a significantly increased risk of developing SPMs of lungs and bronchus (SIR 2.23), skin (SIR 3.09), vulva (SIR 8.5), thyroid (SIR 3.59), nodal NHL (SIR 6.06), extranodal NHL (SIR 11.87), ANLL (SIR 5.77) and AML (SIR 6.37). Patients aged >75 years had a significantly increased risk of developing SPMs of cecum (SIR 2.50), colon (SIR 1.62), soft tissues (SIR 5.25), nodal NHL (SIR 2.38), extranodal NHL (SIR 7.51), ANLL (SIR 3.69) and AML (SIR 3.63). Risk of SPM was significantly increased in both males (SIR 1.39) and females (SIR 1.59). On subsite evaluation, males had a significantly greater risk of SPMs involving lung and bronchus (SIR 1.71), soft tissues (SIR 4.52), skin (SIR 1.88), nodal NHL (SIR 3.85), extra-nodal NHL (SIR 6.9), ANLL (SIR 5.4) and AML (SIR 5.55). Females reported a significantly increased risk of SPM involving cecum (SIR 3.88), skin (SIR 2.87), vagina (SIR 11.51) nodal NHL (SIR 3.86) and extranodal NHL (SIR 13.57). The risk of SPM was significantly greater in Caucasians (SIR 1.46) but not African Americans or other races. The risk of SPM was significantly greater in patients at all latencies. The risk of SPM of cecum (SIR 2.76) and non-melanotic skin cancer (SIR 5.52) was significantly greater in patients with latency of 12-59 months, but not at subsequent latencies. The risk of melanotic skin cancer (SIR 2.61) was significantly greater in patients with latency of 60-119 months but not other latencies. The risk of thyroid cancer (SIR 6.43) was significantly increased for patients with latency 120+ months only. CONCLUSION: This study showed that 17% of WM patients developed SPM. WM patients were at a 53% greater risk of developing SPM compared to the general population. Caucasians and patients aged greater than 50 years were at particularly high risk of developing SPM. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal
Secondary Acute Myeloid Leukemia (sAML) is a subgroup of Acute Myeloid Leukemia (AML) associated with poor outcomes despite recent advancements in chemotherapy. CPX-351 (United States: Vyxeos®), a 1:5 liposomal encapsulation of daunorubicin and cytarabine was approved in 2017 by the US Food and Drug Administration (FDA) for the treatment of newly diagnosed Secondary AML. Previously, the conventional 7+3 Regimen (7 days of cytarabine and 3 days of daunorubicin) was considered first line for the treatment of sAML. However, the pivotal study that led to approval of CPX-351 demonstrated increased Overall Survival (OS) with CPX-351. We report a systematic review of published literature on the efficacy and safety of CPX-351 in patients with sAML, including data from post-market real-world experiences of patients. Materials and Methods Following PRISMA guidelines, we performed a comprehensive literature search for articles published after 2017 using PubMed, Embase, Clinical Trials.gov, Cochrane Library, and Web of Science. Initially 63 articles were identified, and after a thorough screening, we finalized 9 studies including 767 patients, illustrated in Table 1. We analyzed data from patients who received CPX-351 chemotherapy as first-line therapy for sAML. MeSH terms and keywords were 'CPX-351' and 'Leukemia, Myeloid, and Acute'. Results The median age of patients was 65.9 years. Patients could receive up to two cycles of induction, and those who achieved complete remission (CR) or complete remission with incomplete recovery (CRi) could receive up to 2 cycles of consolidation with CPX-351. CPX-351 treatment showed median overall survival (mOS) of 12.20 months, CR rate of 43.66%, and an overall remission rate (ORR) of 51.1%. Hematopoietic Stem Cell Transplantation (HSCT) was performed in 39.1% patients. The mean time to absolute neutrophil count &gt;500/mL (mANC) and platelet count &gt;50,000/mL (mPC) recovery in patients who achieved OR was 34.4 days and 32.9 days, respectively. The most frequently reported greater than grade 2 adverse events (AEs) were febrile neutropenia (NF), opportunistic infections including pneumonia, and hypoxia. Conclusion In sAML patients, the CPX-351 regimen is more effective and well tolerated as compared to the conventional 7+3 Regimen. The real-world data also points to CPX-351 as an efficient therapeutic agent for sAML patients facilitating HSCT in many patients with promising outcomes after transplantation. CPX-351 is a treatment of choice for patients aged &gt;60 years. Future randomized prospective trials with longer follow-up periods are needed to consolidate these findings, and help us better understand the efficacy and survival outcomes of CPX351 regimens for sAML treatment.
Introduction: Acute Myeloid Leukemia (AML) remains the most prevalent acute leukemia in adults, often associated with a bleak prognosis. Current treatment recommendations for elderly AML patients incorporate a combination of venetoclax (Ven) and azacitidine (AZA) following trials that underscored Ven's efficacy. This review seeks to analyze and summarize the literature concerning the effectiveness and safety of the Ven + AZA regimen for adult patients with newly diagnosed (ND) and relapsed/refractory (R/R) AML, and those unsuitable for intensive chemotherapy. Materials and Methods: Following PRISMA guidelines, a comprehensive electronic literature search was conducted across PubMed, Embase, Clinicaltrials.gov, Cochrane Library, and Web of Science from inception to 2023. MeSH terms and relevant keywords for (Leukemia, Myeloid, Acute) AND (Venetoclax) AND (Azacitidine) were used. From 327 initially identified articles, 12 studies were selected for inclusion, and citation searching further added 2 studies, summing up to 14. We analyzed data from a combined patient pool of 1256. Results: The review encompassed 13 non-randomized and 1 randomized clinical trials. The median patient age was 75.2 years. Primary outcomes comprised complete remission (CR) and complete remission with incomplete count recovery (CRi), yielding a pooled CR/CRi of 57.8%. Secondary outcomes included an overall response rate (ORR) of 61.1%, and a median overall survival (mOS) of 8.94 months with a median follow-up duration of 13.25 months (Table 1). Notably, high-grade adverse effects were predominantly hematological (anemia, neutropenia, thrombocytopenia, febrile neutropenia) while low-grade effects primarily involved gastrointestinal symptoms (nausea, vomiting, diarrhea, constipation, decreased appetite, etc). Conclusion: The current data suggest that the Ven + AZA regimen is both efficacious and well-tolerated for treating newly diagnosed and relapsed/refractory AML. Cytopenias across all three cell lines emerged as the most reported adverse effects of Ven + AZA therapy. Ongoing Phase III clinical trials are expected to enhance our understanding of this regimen's efficacy and safety profile, solidifying its role in standard AML therapy.
Introduction: Brain metastasis in gastric cancer (GC) is a rare manifestation associated with poor prognosis and unfavorable outcomes. Identification of risk factors is essential for early detection and treatment. We investigated the incidence, risk factors, and prognostic factors of brain metastasis in GC patients. Methods: Data on sociodemographic and tumor characteristics of GC patients from 2010 to 2018 were retrieved from the Surveillance, Epidemiology, and End-Results database. Overall survival (OS) was defined as the time from diagnosis to death from any cause or end of follow-up. Cancer-specific survival (CSS) was defined as the time from diagnosis to death due to GC or end of follow-up. Descriptive statistics, multivariate logistic regression, and Cox regression were applied using SPSS version 26. Kaplan Meier survival curves were constructed (Figure). Results: We included 7,960 patients with GC (Table). Brain metastasis was reported in 31 (0.39 %) patients. On logistic regression, patients who had undergone surgery were at reduced risk for brain metastasis (adjusted odds ratio (aOR) 0.086, P< 0.001). Increased risk of brain metastasis was reported in patients who had concurrent metastasis to bone (aOR 4.973, P < 0.001) and lung (aOR 5.816, P < 0.001). The median OS was significantly lower in patients with brain metastasis (5 months) compared to those without brain metastasis (21 months, P < 0.05). The median CSS was significantly lower in patients with brain metastasis (5 months) compared to those without brain metastasis (25 months, P < 0.05). On Cox regression, significantly reduced OS was reported in patients at T3 (AHR 7.549) and T4 stage (adjusted hazard ratio (aHR) 19.394). OS was prolonged in patients who had undergone surgery (aHR 0.043). CSS was significantly reduced in patients at T3 (aHR 6.234) and T4 stage (aHR 17.148). Patients who had undergone surgery had longer CSS (aHR 0.04). Conclusion: Metastasis to the brain was reported in only 0.39% of GC patients. Brain metastasis is associated with worse OS and CSS in GC, particularly in patients with advanced tumor stage and those who did not undergo surgery.Figure 1.: Kaplan Meier Survival Analysis for Gastric Cancer with and without Brain Metastasis. Table 1. - Baseline Characteristics of Patients with Gastric Cancer Features Brain Metastasis, n (%) No metastasis, n (%) P-value Total 31 (100) 7929 (100) Race 0.068 Caucasian 27 (87.1) 5390 (68.0) African American 2 (6.5) 850 (10.7) Other 2 (6.5) 1689 (21.3) Sex 0.709 Male 19 (61.3) 5122 (64.6) Female 12 (38.7) 2807 (35.4) Age, years 0.046* Less than 50 3 (9.7) 862 (10.9) 50-75 24 (77.4) 4476 (56.5) More than 75 4 (12.9) 2591 (32.7) T Stage 0.597 0 0 (0) 23 (0.29) 1 10 (32.2) 2478 (31.3) 2 1 (3.2) 1009 (12.7) 3 13 (41.9) 2775 (35.0) 4 7 (22.6) 1644 (20.7) N Stage 0.527 0 12 (38.7) 4034 (50.9) 1 12 (38.7) 2221 (28.0) 2 4 (12.9) 901 (11.4) 3 3 (9.7) 773 (9.7) Surgery < 0.001 Yes 2 (6.4) 4439 (56.0) No 29 (93.5) 3490 (44.0) Bone Metastasis < 0.001 Yes 10 (32.3) 231 (2.9) No 21 (67.7) 7698 (97.1) Liver Metastasis < 0.001 Yes 11 (35.5) 811 (10.2) No 20 (64.5) 7118 (89.8) Lung Metastasis < 0.001 Yes 10 (32.2) 222 (2.8) No 21 (67.7) 7707 (97.2)
Introduction: Gastrointestinal stromal tumor (GIST) are the most frequent mesenchymal neoplasms in the digestive tract. Second primary malignancies (SPM) have been reported frequently, either synchronously or during follow-up, in patients diagnosed with GIST. We analyzed the incidence and location of SPM in patients with GIST. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results database (SEER) to filter out patients diagnosed with GISTs. Patients with GIST diagnosed between 1975 and 2019 and confirmed on histopathology were included, while those diagnosed at autopsy or lost to follow-up were excluded. SPM was defined as a second tumor diagnosed more than 60 days after the initial GIST diagnosis. Standardized incidence ratio (SIR) and absolute excess risk (AER) were calculated using SEER*Stat software (version 8.4.0.1). P-values and 95% confidence intervals (95% CI) were generated assuming Poisson distribution of observed incidence of SPM. Results: Overall, 3,202 GIST patients were included (mean age 62.36 years). SPM was reported in 328 (10.2%) patients. Patients with GIST had a significantly greater risk of developing SPM in any location as compared to the general population with SIR = 1.25 (95% CI = 1.11-1.39) and AER of 32.86 per 10,000 population. The most common site for SPM was the digestive tract, specifically the colon (SIR = 1.53, 95% CI = 1.01-2.22) and stomach (SIR = 2.50, 95% CI = 1.29-4.37). Other locations where site-specific risk was significantly increased were the lungs, bronchus and trachea (SIR 1.69), soft tissues (SIR 5.27), skin (SIR 1.71), kidney (SIR 2.34), thyroid (SIR 4.13), and chronic myeloid leukemia (SIR 4.15) (Table 1). Increased risk of SPM was reported for patients aged 50-75 years (SIR = 1.28) but not for patients younger than 50 or older than 75. There was a significantly increased risk of developing SPM in all races; the SIR for Caucasians, African-Americans, and other races (American Indian/AK Native, Asian/Pacific Islander) were 1.19, 1.45, and 1.34, respectively. Increased risk of SPM was reported for latency 2-11 months (SIR 2.31) but not for latencies 12-59 months (SIR 1.06), 60-119 months (SIR 1.05), or 120+ months (SIR 1.29). Conclusion: Patients with GIST are at a high risk of developing SPM, especially tumors of the digestive and respiratory tract, along with chronic myeloid leukemia. Data suggests a higher incidence of SPM in patients aged 50-75 years and with 2-11 months latency. Table 1. - Secondary Primary Malignancy Sites Location Observed Expected SIR 95% CI AER All Sites 328 263.3 1.25# 1.11-1.39 32.86 All Solid Tumors 287 227.57 1.26# 1.12-1.42 30.18 Stomach 12 4.8 2.50# 1.29-4.37 3.66 Colon 27 17.69 1.53# 1.01-2.22 4.46 Sigmoid Colon 10 4.34 2.30# 1.1-4.24 2.87 Lung, and bronchus 60 35.46 1.69# 1.29-2.18 12.49 Skin excluding Basal and Squamous 22 12.86 1.71# 1.07-2.59 4.64 Soft Tissue including Heart 8 1.52 5.27# 2.27-10.38 3.29 Kidney 19 8.1 2.34# 1.41-3.66 5.53 Chronic Myeloid Leukemia 4 0.96 4.15# 1.13-10.62 1.54 Thyroid 16 3.87 4.13# 2.36-6.71 6.16 #represents P< 0.05.SIR : Standardized incidence ratio, AER : Absolute excess risk, 95%CI : 95% Confidence Interval.
Introduction: Multiple myeloma (MM) is a hematological malignancy characterized by the abnormal proliferation of monoclonal plasma cells in the bone marrow, leading to symptoms such as bone pain, hypercalcemia, and renal dysfunction. A significant advancement in the treatment of MM is autologous hematopoietic stem cell transplantation, which has been effectively utilized to improve patient outcomes. This meta-analysis aims to explore the comparative efficacy and safety profile of Busulfan plus low dose Melphalan (BUMEL) versus High dose Melphalan (HDMEL) as a conditioning regimen for Autologous Hematopoietic stem cells transplantation in patients of Multiple Myeloma. Methods: A comprehensive literature review including 13 final studies was conducted using PubMed, Cochrane, and Embase. We included randomized controlled trials focused on patients with multiple myeloma treated with Busulfan plus low-dose Melphalan and high-dose Melphalan. A hazard ratio (HR) corresponding to a 95% confidence Interval (CI) was adopted to assess OS and PFS. The DerSimonian and Laird random effects model was used to pool Hazard ratios (HR) and dichotomous outcomes were pooled using risk ratio while continuously using Mean difference. The random effects model was used using the inverse variance method. a p-value of &lt;0.5 was considered statistically significant. Results: The BUMEL-based conditioning regimen was found to be more favorable regarding progression-free survival (PFS) compared to the HDMEL regimen (HR 0.89; 95% CI 0.77-0.97, P = 0.006). However, overall survival (OS) was comparable between the two therapeutic groups, with no statistically significant difference observed (HR 1.12; 95% CI 0.82-1.43, P = 0.76). Regarding the safety profile, gastrointestinal side effects were less common with the BUMEL regimen (OR 0.81; 95% CI 0.57-0.90, P &lt; 0.004) compared to HDMEL. Conversely, other side effects such as mucositis, infections, and hepatic toxicity were more prevalent with BUMEL-based therapy. Conclusion: In our meta-analysis, the BUMEL-based regimen demonstrated higher effectiveness in terms of progression-free survival (PFS), with this comparison being statistically significant. Although overall survival (OS) also favored the BUMEL-based therapy, there was no statistically significant difference between the two groups. The overall toxicity profile was higher in the BUMEL group, except gastrointestinal toxicity, which was less common, thus balancing the efficacy and safety profiles between the BUMEL and HDMEL regimens. Keywords: Autologous Hematopoietic stem cell transplantation, BUMEL, HDMEL, Multiple Myeloma.
Trichobezoars are accumulations of undigested hair. Usually, this disorder follows a psychiatric etiology; however, sometimes a nonpsychiatric etiology, such as pica, can also be suspected. Rapunzel syndrome is a rare type of trichobezoar in which the hair is usually confined to the stomach and small intestine. The authors present a rare case of trichobezoar in a young female without any psychiatric symptoms. Trichobezoar results in nonspecific GI symptoms and this causes delays in its diagnosis. It should always be considered a differential in a young female with nonspecific GI symptoms, especially in those with evidence of iron deficiency anemia.
Cerebral small vessel disease (CSVD) involves pathophysiological changes in the function and anatomy of the brain that affect its activity. Electroencephalogram (EEG) signals reflect the electrophysical activities of the brain and can be non-invasively measured with wearable devices. EEG has been used in the detection of CSVD-related cognitive impairment. Recently, development of artificial intelligence (AI) technologies provides new potential for EEG-enhanced diagnosis of CSVD. In this chapter, we review the state of the art and summarize the recent advancements as well as limitations to provide future directions for the EEG-based detection of CSVD. This chapter provides a reference for clinicians, physiologists, and biomedical engineers.
Cerebral small vessel disease (CSVD) is a term that relates to a large number of pathological changes in the microvessels of the brain. With advances in technology in terms of hardware, imaging processing algorithms, and data science, new biomarkers associated with CSVD have been extracted from neuroimaging data. This chapter provides an overview of neuroimaging modalities for CSVD, including computed tomography, magnetic resonance imaging (MRI), diffusion MRI, iron imaging, myelin imaging, cerebrovascular reactivity imaging, and vessel wall imaging. It also discusses existing and emerging or novel biomarkers from the different investigation modalities. We evaluate the diagnostic values of these neuroimaging biomarkers from a clinical perspective and summarize the limitations as well as future directions.
Cerebral small vessel disease (CSVD) is a significant contributor to cognitive decline, stroke, and dementia. This chapter explores the role of biomarkers in CSVD, examining their potential in diagnosis, prognosis, and disease monitoring. We discuss various biomarkers related to endothelial dysfunction, inflammation, and neuroimaging features. The chapter highlights the clinical implications of these biomarkers, current challenges in their application, and future directions in CSVD biomarker research. Emerging technologies, multi-marker approaches, and the potential for personalized medicine are considered. While significant progress has been made, further research is needed to fully realize the potential of biomarkers in improving CSVD management and patient outcomes.
Introduction: The clinical efficacy of simvastatin as an adjunct therapy in patients with liver cirrhosis remains uncertain. Statins are believed to reduce portal pressure and suppress inflammation. We conducted a meta-analysis to assess the clinical impact of simvastatin in patients with liver cirrhosis. Methods: We performed a systematic literature search in PubMed, Embase, Cochrane Library, and ClinicalTrials.gov using MeSH terms for ‘Simvastatin’ and ‘Liver Cirrhosis’. All randomized controlled trials (RCTs) evaluating simvastatin as an adjunct therapy compared with controls were included. For continuous outcomes, standardized mean differences (SMDs) were pooled; for dichotomous outcomes, risk ratios (RRs) were calculated. All estimates were presented with 95% confidence intervals (CIs) and combined with a random-effects model. Results: Total 9 studies recruiting 1,014 patients were included. Four studies reported on the effect of simvastatin on mortality, with no significant difference observed between the simvastatin and control groups [risk ratio (RR): 0.63; 95% confidence interval (CI), 0.38 -1.04; P = 0.07]. Both groups were comparable in terms of complications such as Bleeding [RR 0.70, 95% CI 0.45 - 1.08; P = 0.10], new or worsening ascites [RR 0.91, 95% CI 0.69 - 1.21; P = 0.51], and development of acute kidney injury or hepatorenal syndrome [RR 0.85, 95% CI 0.649 - 1.87; P = 0.57]. There was no statistically significant difference in hepatic hemodynamic measurements such as hepatic venous pressure gradient (HVPG) [standardized mean difference (SMD) -0.19, 95% CI -0.49 - 0.11; P = 0.21], wedged hepatic venous pressure (WHVP) [ SMD -0.11, 95% CI -0.44 - 0.23; P = 0.53], and Free hepatic venous pressure (FHVP) [SMD 0.04, 95% CI -0.21 - 0.29; P = 0.76] between the 2 groups. Conclusion: This meta-analysis demonstrates that simvastatin as an adjunct therapy in patients with liver cirrhosis, does not significantly impact mortality, incidence of complications (including bleeding, ascites, and renal dysfunction) or hepatic hemodynamic parameters. Although statins have shown theoretical benefits in reducing portal pressure and inflammation, the current evidence does not support a clear clinical advantage of simvastatin in this population. Further high-quality, large scale and adequately powered randomized controlled trials are warranted to better clarify its potential role in the management of liver cirrhosis.
I am currently working on a study to examine the effect of copper deficiency on the number of white blood cells, Neutrophils in particular,…
