Urban river recovery: a systematic review on the effectiveness of water clean-up programs

Urban rivers are affected at different levels by the intensification of human activities, representing a serious threat to the maintenance of terrestrial life and sustainable urban development. Consequently, great efforts have been dedicated to the ecological restoration of urban rivers around the world, as a solution to recovering the environmental functionality of these environments. In this sense, the present work aimed to investigate the effectiveness of interventions carried out aimed at the recovery of urban rivers, through a systematic review of the literature between 2010 and 2022, using the search term "rivers recovery." The results showed that there have been notable advances in the implementation of river recovery programs in urban areas around the world between the years analyzed. The ecosystems studied were affected, for the most part, by the increase in the supply of nutrients from domestic and industrial effluents, in addition to having highly urbanized surroundings and with several changes in land use patterns. The preparation of this literature review made it possible to demonstrate that the effectiveness of river recovery is extremely complex, since river recovery projects are developed for different reasons, as well as being carried out in different ways according to the intended objective.

Piriformis syndrome

Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.

Comparison between compressed sensing and segmented cine cardiac magnetic resonance: a meta-analysis

PURPOSE

Highly accelerated compressed sensing cine has allowed for quantification of ventricular function in a single breath hold. However, compared to segmented breath hold techniques, there may be underestimation or overestimation of LV volumes. Furthermore, a heterogeneous sample of techniques have been used in volunteers and patients for pre-clinical and clinical use. This can complicate individual comparisons where small, but statistically significant differences exist in left ventricular morphological and/or functional parameters. This meta-analysis aims to provide a comparison of conventional cine versus compressed sensing based reconstruction techniques in patients and volunteers.

METHODS

Two investigators performed systematic searches for eligible studies using PubMed/MEDLINE and Web of Science to identify studies published 1/1/2010-3/1/2021. Ultimately, 15 studies were included for comparison between compressed sensing cine and conventional imaging.

RESULTS

Compared to conventional cine, there were small, statistically significant overestimation of LV mass, underestimation of stroke volume and LV end diastolic volume (mean difference 2.65 g [CL 0.57-4.73], 2.52 mL [CL 0.73-4.31], and 2.39 mL [CL 0.07-4.70], respectively). Attenuated differences persisted across studies using prospective gating (underestimated stroke volume) and non-prospective gating (underestimation of stroke volume, overestimation of mass). There were no significant differences in LV volumes or LV mass with high or low acceleration subgroups in reference to conventional cine except slight underestimation of ejection fraction among high acceleration studies. Reduction in breath hold acquisition time ranged from 33 to 64%, while reduction in total scan duration ranged from 43 to 97%.

CONCLUSION

LV volume and mass assessment using compressed sensing CMR is accurate compared to conventional parallel imaging cine.

Investigation of Unexplained Cardiac Arrest: Phenotyping and Genetic Testing

Unexplained cardiac arrest (UCA) is a working diagnosis that should be replaced by a final diagnosis once evaluation is completed. Complete evaluation of UCA should include high-yield tests like cardiac magnetic resonance imaging, exercise treadmill test, and sodium-channel blocker challenge to identify latent causes of UCA. If no clear etiology is revealed after complete evaluation, idiopathic ventricular fibrillation may be diagnosed, and the strength of its diagnosis can be divided into definitive, probable, and possible based on the number of high-yield tests performed. Care should be provided by a multidisciplinary team with expertise in this area.

Computer-aided breast cancer detection and classification in mammography: A comprehensive review

Cancer is the second cause of mortality worldwide and it has been identified as a perilous disease. Breast cancer accounts for ∼20% of all new cancer cases worldwide, making it a major cause of morbidity and mortality. Mammography is an effective screening tool for the early detection and management of breast cancer. However, the identification and interpretation of breast lesions is challenging even for expert radiologists. For that reason, several Computer-Aided Diagnosis (CAD) systems are being developed to assist radiologists to accurately detect and/or classify breast cancer. This review examines the recent literature on the automatic detection and/or classification of breast cancer in mammograms, using both conventional feature-based machine learning and deep learning algorithms. The review begins with a comparison of algorithms developed specifically for the detection and/or classification of two types of breast abnormalities, micro-calcifications and masses, followed by the use of sequential mammograms for improving the performance of the algorithms. The available Food and Drug Administration (FDA) approved CAD systems related to triage and diagnosis of breast cancer in mammograms are subsequently presented. Finally, a description of the open access mammography datasets is provided and the potential opportunities for future work in this field are highlighted. The comprehensive review provided here can serve both as a thorough introduction to the field but also provide indicative directions to guide future applications.

Update on the use of ultrasound in the diagnosis and monitoring of the critical patient

Hemodynamic and respiratory complications are the main causes of morbidity and mortality in in critical care units (CCU). Imaging techniques are a key tool in differential diagnosis and treatment. In the last decade, ultrasound has shown great potential for bedside diagnosis of respiratory disease, as well as for the hemodynamic assessment of critically ill patients. Ultrasound has proven to be a useful guide for identifying the type of shock, estimating cardiac output, guiding fluid therapy and vasoactive drugs, providing security in the performance of percutaneous techniques (thoracentesis, pericardiocentesis, evacuation of abscesses/hematomas), detecting dynamically in real time pulmonary atelectasis and its response to alveolar recruitment maneuvers, and predicting weaning failure from mechanical ventilation. Due to its dynamic nature, simple learning curve and absence of ionizing radiation, it has been incorporated as an essential tool in daily clinical practice in CCUs. The objective of this review is to offer a global vision of the role of ultrasound and its applications in the critically ill patient.

Celebrating Higher Education's 50 years: trends, absences, and opportunities

The journal, Higher Education (HE), was established in 1972 and is currently one of the leading international journals in higher education studies. By using bibliometric techniques, a systematic review, and a social network analysis, this review article provides an overview of the main patterns of publications in HE during its history. The findings show that (i) the volume of articles has been continuously increasing, with a particular marked uplift since 2007; (ii) while single-authored articles have dominated the publication pattern, collaborative articles have shown a particular growth over the last decade; (iii) the USA, the UK, and Australia have dominated the journal in terms of the number of articles, international collaboration, and the most prolific authors; (iv) while Chinese authors have become more evident, there has been a near-absence of contributions from Latin America, Eastern Europe, and most of Africa; (v) in the entire history of HE, there has been a gender imbalance (in favour of male authors) across the most cited articles, but this pattern has changed in the last decade and; (vi) both teaching and learning and system policy have been key research themes in the journal although internationalisation and the student experience have recently gained traction. These patterns of publication in HE, with their imbalances and absences, suggest several challenges ahead.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10734-022-00924-7.

Should antidiabetic medicines be considered to reduce cardiometabolic risk in patients with serious mental illness?

Substantially reduced life expectancy for people with serious mental illness compared with the general population is primarily driven by physical health issues, of which cardiovascular disease is the leading cause. In this narrative review, we examine the evidence base for use of metformin and other antidiabetic agents as a means for reducing this excess cardiometabolic disease burden. Evidence from randomised controlled trials (RCTs) suggests substantial potential for metformin to prevent or manage weight gain and glycaemic impairment induced by atypical antipsychotic medications, whereas the impact of metformin on other cardiometabolic risk factors is less consistent. Evidence from RCTs also suggests potential benefits from glucagon-like peptide-1 receptor agonists (GLP-1RAs), particularly for addressing cardiometabolic risk factors in people using atypical antipsychotic medications, but this is based on a small number of trials and remains an emerging area of research. Trials of both metformin and GLP-1RAs suggest that these medications are associated with a high prevalence of mild-moderate gastrointestinal side effects. The heterogeneous nature of participant eligibility criteria and of antipsychotic and antidiabetic drug regimens, alongside short trial durations, small numbers of participants and paucity of clinical endpoints as trial outcomes, warrants investment in definitive trials to determine clinical benefits for both metformin and GLP-1RAs. Such trials would also help to confirm the safety profile of antidiabetic agents with respect to less common but serious adverse effects. The weight of RCT evidence suggests that an indication for metformin to address antipsychotic-induced weight gain is worth considering in Australia. This would bring us into line with other countries.

Medical Autopsy for Sudden Unexplained Death in Saudi Arabia: A Call to Action

Sudden unexplained death (SUD) is a sudden, unexpected, and unexplained death in an individual older than 1 year. It is one of the most devastating and tragic events to families and the community at large, particularly when it happens at a young age. Finding the cause of SUD is extremely important in order to prevent its recurrence in the family, and to help understand the epidemiology of SUD in the community. It has been well-established that the most effective way of finding the cause of SUD is by performing a medical autopsy. In many countries, medical autopsy is mandated in SUD cases. In others, however, medical autopsy is rarely performed for the purpose of identifying the cause of SUD, which is the case in Saudi Arabia. In this review, we discussed the importance of finding the cause of death in SUD cases, the role of different types of medical autopsies, and the state of medical autopsy in Saudi Arabia. Moreover, we proposed a clinical pathway to incorporate medical autopsy in the care of SUD cases, and to connect family members to the health care system in order to perform cascade screening.

Interrogating the intentions for Aboriginal and Torres Strait Islander health: a narrative review of research outputs since the introduction of Closing the Gap

Despite the "best of intentions", Australia has fallen short of federal targets to close the gap in disproportionate health outcomes between Aboriginal and non-Aboriginal Australians. We examined 2150 original research articles published over the 12-year period (from 2008 to 2020), of which 58% used descriptive designs and only 2.6% were randomised controlled trials. There were few national studies. Studies were most commonly conducted in remote settings (28.8%) and focused on specific burdens of disease prevalent in remote areas, such as infectious disease, hearing and vision. Analytic observational designs were used more frequently when addressing burdens of disease, such as cancer and kidney and urinary, respiratory and endocrine diseases. The largest number of publications focused on mental and substance use disorders (n = 322, 20.5%); infectious diseases (n = 222, 14.1%); health services planning, delivery and improvement (n = 193, 33.5%); and health and wellbeing (n = 170, 29.5%). This review is timely given new investments in Aboriginal health, which highlights the importance of Aboriginal researchers, community leadership and research priority. We anticipate future outputs for Aboriginal health research to change significantly from this review, and join calls for a broadening of our intellectual investment in Aboriginal health.

Green grain warehousing: bibliometric analysis and systematic literature review

Grain warehousing contributes persistent environmental effects in the food supply chain because of its long-term storage feature and distribution requirements. Thus, it has attracted a number of interdisciplinary researchers to the investigations of green grain warehousing (GGW) over the past decades. This paper presents a valuable comprehensive literature review on the existing publications on this topic via bibliometric analysis and systematic review based on 37 papers obtained from three common international academic databases, namely Web of Science, Scopus, and EBSCOhost. We concluded a framework of existing literature with proposing three macro-themes (energy-saving in transporting, environmental harmony, and green deinsectization) as well as a classification of commonly used methods. The results revealed that (1) the increase in research interests over years was found; (2) there are differences in the attention of GGW among countries. Most of the scholars from developing countries focused more on the green operational technologies or strategies, while most of the scholars from developed countries placed their research focuses on keeping grain quality and developing environment-friendly deinsectization approaches with low emission or chemical alternatives; (3) grain quality started to become the most popular hotspot in recent years; (4) the researchers tended to use more comprehensive methodologies or combined methods to conduct their works. Accordingly, we proposed potential research directions. The contribution of this work is to extend current literature and to offer reference to scholars and practitioners for future research and operation in GGW.

Lipids and diastolic dysfunction: Recent evidence and findings

AIM

Diastolic dysfunction is the decreased flexibility of the left ventricle due to the impaired ability of the myocardium to relax and plays an important role in the pathogenesis of heart failure. Lipid metabolism is a well-known contributor to cardiac conditions, including ventricular function. In this article, we aimed to review the literature addressing the connections between lipids, their storage, and metabolism with left ventricular diastolic dysfunction.

DATA SYNTHESIS

We searched Google scholar, Pubmed, Embase and Researchgate for our keywords: "Diastolic function", "Fat" and "Lipid profile". Initially, 250 articles were selected by title and 84 of them were chosen as most relevant and directly reviewed.

CONCLUSIONS

Alterations of lipid metabolism in cardiac muscle and cardiac lipid content can occur in many conditions, including consumption of a high-fat diet, obesity, metabolic syndrome, and non-alcoholic fatty liver disease (NAFLD). These conditions induce alterations in myocardial lipid metabolism, increase myocardial fat content and epicardial fat thickness and increase inflammation and oxidative stress which ultimately lead to cardiac lipotoxicity and diastolic dysfunction. The effects of lipids on diastolic function can differ based on gender. Lipid profile and metabolism are as important in the pathogenesis of diastolic dysfunction as they are in other cardiovascular disorders. A more careful look at cardiac lipid metabolism in molecular, histological and gross levels results in more precise understanding of its role in myocardial function and leads to development of potential treatments for diastolic dysfunction.

Potential indirect impacts of the COVID-19 pandemic on children: a narrative review using a community child health lens

▪In this narrative review, we summarise the vast and burgeoning research on the potential and established indirect impacts on children of the COVID-19 pandemic. We used a community child health lens to organise our findings and to consider how Australia might best respond to the needs of children (aged 0-12 years). ▪We synthesised the literature on previous pandemics, epidemics and natural disasters, and the current COVID-19 pandemic. We found clear evidence of adverse impacts of the COVID-19 pandemic on children that either repeated or extended the findings from previous pandemics. ▪We identified 11 impact areas, under three broad categories: child-level factors (poorer mental health, poorer child health and development, poorer academic achievement); family-level factors that affect children (poorer parent mental health, reduced family income and job losses, increased household stress, increased abuse and neglect, poorer maternal and newborn health); and service-level factors that affect children (school closures, reduced access to health care, increased use of technology for learning, connection and health care). ▪There is increasing global concern about the likely disproportionate impact of the current pandemic on children experiencing adversity, widening existing disparities in child health and developmental outcomes. ▪We suggest five potential strategy areas that could begin to address these inequities: addressing financial instability through parent financial supplements; expanding the role of schools to address learning gaps and wellbeing; rethinking health care delivery to address reduced access; focusing on prevention and early intervention for mental health; and using digital solutions to address inequitable service delivery.

Small bowel diverticula in elderly patients: a case report and review article

Background

Small intestine diverticula are rare findings that were mostly reported in the elderly population as asymptomatic findings. However, they can also present with a wide range of symptoms (bloating, early satiety, chronic abdominal discomfort, and diarrhea/steatorrhea) or complications (gastrointestinal bleeding, small bowel obstruction, acute diverticulitis, or perforation) which in turn warrant medical treatment or urgent surgical intervention.

Case presentation

This is a case report of an 84-year-old female who presented with an acute surgical abdomen. An exploratory laparotomy revealed complicated small bowel diverticula with a jejunal diverticulum perforation, for which a diverticulectomy was performed.

Conclusions

Throughout this paper, we are aiming to outweigh the consideration of the possibility of complicated small bowel diverticula as a differential in the evaluation of any acute abdomen, especially in the elderly, which warrants emergency surgical management.

Clubfoot

Clubfoot or talipes equinovarus deformity is one of the most common anomalies affecting the lower extremities. This review provides an update on the outcomes of various treatment options used to correct clubfoot. The ultimate goal in the treatment of clubfoot is to obtain a fully functional and pain-free foot and maintain a long-term correction. The Ponseti method is now considered the gold standard of treatment for primary clubfoot. Relapse is common after primary treatment with the Ponseti method, and other interventions are discussed that are used to provide for long-term successful outcomes.

What are the effects of scuba diving-based interventions for clients with neurological disability, autism or intellectual disability? A systematic review

INTRODUCTION

Recreational scuba diving has existed for over 70 years with organisations emerging that teach individuals with disabilities to dive. It is unclear what the physical and psychosocial effects of scuba interventions might be. This systematic review explores evidence for the effects of scuba diving in individuals with neurological disability, intellectual disability and autism.

METHODS

The databases Medline, EMBASE, Ovid Emcare, and SportDiscus were searched. Included papers described a scuba-based intervention for clients with a neurological disability, intellectual disability and autism, with physical or psychosocial outcomes explored in the paper. Quality of the included papers was assessed using the McMaster Appraisal Tools, with descriptive data synthesis completed to explore the physical and psychosocial effects of the interventions.

RESULTS

Four papers met the inclusion criteria: a cross-sectional investigation, a phenomenological study, a case-control study and a multiple case study. The quality of the papers was low to moderate. Papers addressed the psychosocial effects of scuba diving, including motivation to participate, participant experiences, the effect on cognition and physical self-concept. One study reported an increase in self-concept for the majority of participants. An increase in understanding instructions and in visual attention was reported in another. Enjoyment of the activity was reported and motivators to be involved in scuba diving for people with disabilities included fun and excitement. No papers addressed functional outcomes.

CONCLUSIONS

Whilst scuba diving interventions appear to enhance physical self-concept and are enjoyable, conclusive evidence regarding effectiveness could not be determined. Research in this area is extremely limited.

"Parkinson's disease" on the way to progressive supranuclear palsy: a review on PSP-parkinsonism

Progressive supranuclear palsy (PSP) is a progressive atypical parkinsonian syndrome characterised by postural instability, supranuclear ophthalmoplegia, dysarthria, dysphagia, executive dysfunction and other features. This clinical presentation represents the classic PSP-Richardson syndrome (PSP-RS). However, several other clinical subtypes have been recognised, including PSP-parkinsonism (PSP-P), probably the second most common PSP variant. Unlike PSP-RS, PSP-P often presents with an asymmetric onset, tremor and a moderate initial response to levodopa, especially during the first years of the disease, thus resembling Parkinson's disease (PD). It runs a more favourable course, but over time, PSP-P may evolve clinically into PSP-RS. Therefore, it may seem that PSP-P stands clinically between PD and PSP. There are several peculiarities that can distinguish PSP-P from these entities. As there is lack of systematic reviews on PSP-P in the literature, we decided to summarise all the necessary data about the epidemiology, clinical picture, neuroimaging, genetics and other aspects of this PSP variant in order to provide complete information for the reader.

A content analysis by bibliometry of the first ten years of the International Journal of Paleopathology

OBJECTIVES

The aim is to provide an overview of the nature of the content of palaeopathology articles in the International Journal of Paleopathology during the first ten years of publication (2011-2020), and to compare these results with those from other similar journals.

METHODS

The method used is bibliometry of International Journal of Paleopathology plus nine other periodicals publishing in the field of osteoarchaeology / palaeopathology. In these ten journals, 2513 publications in human osteology are reviewed of which 1032 are devoted specifically or substantially to palaeopathology.

RESULTS

International Journal of Paleopathology has attracted a large number of palaeopathology publications, but this has not been at the expense of extant journals. Its appearance appears to have coincided with an expansion of the discipline, and it may also act as a focus for publication for articles that would not previously have found a venue. Its output is distinctive from other journals assessed, with greater emphasis on review articles (including those focusing on method and theory in palaeopathology) and, especially, on case reports.

SIGNIFICANCE

International Journal of Paleopathology acts as a focal point for publications from diverse areas of the field. The connection with the Paleopathology Association provides a conduit by which outcomes of debates within the profession concerning future priorities for the field (e.g. development of method and theory; the status of the case report within the discipline) can be reflected in journal policy.

LIMITATIONS

Palaeopathology and other osteoarchaeology articles are published in venues other than those analysed in the current work.

Persistent pathology of the patent foramen ovale: a review of the literature

A patent foramen ovale (PFO) is an interatrial shunt, with a prevalence of 20-34% in the general population. While most people do not have secondary manifestations of a PFO, some reported sequelae include ischaemic stroke, migraine, platypnoea-orthodeoxia syndrome and decompression illness. Furthermore, in some cases, PFO closure should be considered for patients before neurosurgery and for patients with concomitant carcinoid syndrome. Recent trials support PFO closure for ischaemic stroke patients with high risk PFOs and absence of other identified stroke mechanisms. While PFOs can be associated with migraine with auras, with some patients reporting symptomatic improvement after closure, the evidence from randomised controlled trials is less clear in supporting the use of PFO closure for migraine treatment. PFO closure for other indications such as platypnoea-orthodeoxia syndrome, decompression illness and paradoxical embolism are based largely on case series with good clinical outcomes. PFO closure can be performed as a day surgical intervention with high procedural success and low risk of complications.

How to do left atrial late gadolinium enhancement: a review

BACKGROUND

Quantification of left atrial late gadolinium enhancement is a powerful clinical and research tool. Fibrosis burden has been shown to predict the success of pulmonary vein isolation, post-ablation reoccurrence, and major adverse cardiovascular events such as stroke.

OVERVIEW

The standardized cardiovascular magnetic resonance imaging protocols 2020 update describes the key components of the examination. This review is a more in-depth guide, geared toward building left atrial late gadolinium enhancement imaging from the ground up. The standard protocol consists of the following: localization, pulmonary vein magnetic resonance angiography, cardiac cines, left ventricular, and atrial late gadolinium enhancement. We also review typical segmentation and post-processing techniques, as well as discuss pitfalls, limitations, and potential future innovations in this area.

CONCLUSIONS

With sufficient experience and optimized protocols, left atrial late gadolinium enhancement imaging is a strong addition to the cardiac magnetic resonance imaging repertoire.

Examining lung cancer screening utilization with public-use data: Opportunities and challenges

Lung cancer screening with low-dose computed tomography is recommended for high-risk smokers who meet specific eligibility criteria. Current guidelines suggest that eligible adults with a heavy smoking history will benefit from annual low dose computed tomography but due to several associated risks (e.g., false-positives, radiation exposure, overdiagnosis) a shared decision-making consultation is required by the Centers for Medicare & Medicaid Services, and endorsed by the United States Preventive Services Task Force. In order to examine potential for tracking LCS uptake, adherence, and patient-provider communication at a national level, we reviewed four regularly publicly available national surveys (National Health Interview Survey [NHIS], Behavioral Risk Factor Surveillance System [BRFSS], National Health and Nutrition Examination Survey [NHANES], and Health Information National Trends Survey [HINTS]) to assess available data; an overview of 37 publications using these sources is also provided. The results show that none of the surveys include items that fully assess current LCS guidelines. Implications for future research-including the potential to examine factors associated with LCS uptake and patient-provider communication-are addressed.

Metastatic tumour of the hand - Three new cases and a literature review

Metastatic tumours of the hand are rare, and therefore, is the subject of only a few publications in the literature. We report on three new cases along with a retrospective and descriptive study with file and literature analysis dating from 1900 to 2017, which reported on 337 studies. To perform the statistical analysis, ordinary lease square regression was used to group the metastases into distal phalanx, proximal/middle phalanx, thumb, hand and carpus. We found 564 metastases at the hand for a total of 482 patients. Of the reported cases, 60% were male. The average age was 59 years. The main primary cancers were lung cancer (40%), followed by gastrointestinal (19%), genito-urinary (13%), gynaecological (11%) and ear, nose and throat (6%) cancers. The mean survival time was 7.2 months. Fifty-nine per cent was bone metastasis, 18% tissue metastasis and 3% cutaneous metastasis. In 20% of cases, the type of metastasis was not mentioned. Of all the tissue metastases, 47 (54%) were subungual and in that group, the thumb was the finger most commonly affected. Overall, metastases most commonly appeared in the distal phalanx, which can be explained by a greater vascularisation as well as microtraumatisms. Survival was independent of the epidemiological criteria and of the location and type of metastasis. Patients with primary urological cancer lived on average 3 months longer than patients with other types of primary cancers.

Renal and cardiovascular repercussions in preeclampsia and their impact on fluid management: a literature review

Preeclampsia is a multifactorial condition associated with significant morbidity and mortality. Fluid therapy in these patients is challenging since volume expansion may precipitate pulmonary edema, and fluid restriction may worsen renal function. Furthermore, cardiac impairment may introduce an additional component to the hemodynamic management. This article reviews the repercussions of preeclampsia on renal and cardiovascular systems and the development of pulmonary edema, as well as to discuss fluid management, focusing on the mitigation of adverse outcomes and monitoring alternatives. The literature review was carried out using PubMed, Embase, and Google Scholar databases from May 2019 to March 2020. Papers addressing the subjects of interest were included regardless of the publication language. There is a current trend towards restricting the administration of fluids in women with non-complicated preeclampsia. However, patients with preeclampsia may experience hemorrhagic shock, requiring volume resuscitation. In this case, hemodynamic monitoring is recommended to guide fluid therapy while avoiding complications.

Blunt and Penetrating Severe Traumatic Brain Injury

Severe traumatic brain injury is a common problem. Current practices focus on the importance of early resuscitation, transfer to high-volume centers, and provider expertise across multiple specialties. In the emergency department, patients should receive urgent intracranial imaging and consideration for tranexamic acid. Close observation in the intensive care unit environment helps identify problems, such as seizure, intracranial pressure crisis, and injury progression. In addition to traditional neurologic examination, patients benefit from use of intracranial monitors. Monitors gather physiologic data on intracranial and cerebral perfusion pressures to help guide therapy. Brain tissue oxygenation monitoring and cerebromicrodialysis show promise in studies.

The Landmark Series: Multimodal Therapy for Esophageal Cancer

INTRODUCTION

Esophagectomy is the mainstay of treatment for patients with resectable esophageal cancer, and chemotherapy and chemoradiation have become essential adjuncts to improve survival. Controversy remains regarding the optimal perioperative therapy.

METHODS

This review focuses on three landmark, randomized, controlled trials that have greatly influenced esophageal cancer management and established chemotherapy and chemoradiotherapy as standard of care: Medical Research Council Adjuvant Gastric Infusional Chemotherapy Trial (MAGIC); The United Kingdom Medical Research Council Esophageal Cancer Trial (OEO2); and Chemoradiotherapy for Oesophageal Cancer Followed by Surgery Study (CROSS).

RESULTS

The findings from these landmark studies are reviewed and summarized.

CONCLUSION

Chemotherapy regimens are heterogeneous but centered around platinum-based therapy and should be included in the management for all appropriate patients. Ongoing and future studies will further delineate the roles of various chemo- and chemoradiotherapy regimens and also will investigate the promising area of immunotherapy in the treatment of esophageal cancer.

Distal Radioulnar oint Prosthesis

The distal radioulnar joint (DRUJ) prostheses have been available for many years and despite their superior outcomes compared to conventional DRUJ reconstructions in both short and long-term follow-ups, they have not become as popular as common hip and knee prostheses. In the current review article, at the first step, we discussed the applied anatomy and biomechanics of the DRUJ, and secondly, we classified DRUJ prostheses according to available literature, and reviewed different types of prostheses with their outcomes. Finally we proposed simple guidelines to help the surgeon to choose the appropriate DRUJ prosthesis.

Children and diving, a guideline

Scuba diving is an increasingly popular recreational activity in children and adolescents. During the dive medical examination aspects of human physiology, anatomy, and psychology, that differ between adults and children, deserve our special attention. For example, lack of mental maturity, diminished Eustachian tube function and heat loss can pose problems during diving. It is important that children who wish to take up scuba diving are seen by a dive physician, with extra attention to Eustachian tube function. In children, asthma, bronchial hyperreactivity, pulmonary hypertension, and right-to-left shunts are contra-indications for scuba diving. Attention deficit hyperactivity disorder is a relative contra-indication. This article provides a review of the current literature and presents recommendations for recreational diving in children and adolescents. These recommendations are based solely on 'expert' opinion and were accepted by the Dutch Society of Diving and Hyperbaric Medicine in 2020.

A Review on Recent Advances in the Constitutive Modeling of Bone Tissue

PURPOSE OF REVIEW

Image-based finite element analysis (FEA) to predict and understand the biomechanical response has become an essential methodology in musculoskeletal research. An important part of such simulation models is the constitutive material model of which recent advances are summarized in this review.

RECENT FINDINGS

The review shows that existing models from other fields were introduced, such as cohesion zone (cortical bone) or phase-field models (trabecular bone). Some progress has been made in describing cortical bone involving physical mechanisms such as microcracks. Problems with validations at different length scales remain a problem. The improvement of recent constitutive models is partially obscured by uncertainties that affect overall predictions, such as image quality and calibration or boundary conditions. Nevertheless, in vivo CT-based FEA simulations based on a sophisticated constitutive behavior are a very valuable tool for clinical-related osteoporosis research.

Non-contrast coronary magnetic resonance angiography: current frontiers and future horizons

Coronary magnetic resonance angiography (coronary MRA) is advantageous in its ability to assess coronary artery morphology and function without ionizing radiation or contrast media. However, technical limitations including reduced spatial resolution, long acquisition times, and low signal-to-noise ratios prevent it from clinical routine utilization. Nonetheless, each of these limitations can be specifically addressed by a combination of novel technologies including super-resolution imaging, compressed sensing, and deep-learning reconstruction. In this paper, we first review the current clinical use and motivations for non-contrast coronary MRA, discuss currently available coronary MRA techniques, and highlight current technical developments that hold unique potential to optimize coronary MRA image acquisition and post-processing. In the final section, we examine the various research-based coronary MRA methods and metrics that can be leveraged to assess coronary stenosis severity, physiological function, and atherosclerotic plaque characterization. We specifically discuss how such technologies may contribute to the clinical translation of coronary MRA into a robust modality for routine clinical use.

Recurrent giant retroperitoneal liposarcoma with 10 years follow up. Case report and review of literature

INTRODUCTION

This case is of a patient with a recurrent giant retroperitoneal liposarcoma, followed-up and operated multiple times over 10 years. We report this case because of its rarity and review all previous articles reporting "Giant Retroperitoneal Liposarcoma" in the English literature.

CASE DESCRIPTION

A 70 years old man presented to our clinic for dizziness and fatigue. He was incidentally found to have a large retroperitoneal mass filling all the length of the abdominal cavity and shifting all intraabdominal viscera and kidney to the left side. En bloc excision of a 50 × 30 × 18 cm, 9 kg tumor was performed. Final pathology revealed a well-differentiated liposarcoma. Five years later, the patient was reoperated for recurrence and a well-differentiated liposarcoma was excised in 2 pieces (the biggest measuring 14 × 11 × 7 cm) along with the appendix. Four years later the patient was operated on again for a second recurrence, and again a well-differentiated liposarcoma (16 × 10 × 7 cm) extending into the right inguinal canal was excised. One year thereafter, the patient was diagnosed with a third recurrence (22 × 12 cm).

DISCUSSION

Retroperitoneal Liposarcomas are rare tumors, presenting with different histological differentiation. They are diagnosed using multiple imaging modality, mainly CT scan, and it is confirmed by percutaneous large core needle biopsy. R0 Surgical excision remains the proper treatment for non-metastatic tumors, which may necessicate multiorgan resection. They rarely grow to reach a large size and be labled as "Giant Retroperitoneal Liposarcoma".

Neospora caninum infection in Iran (2004-2020): A review

Knowledge on neosporosis and associated risk factors in different species of animals are so important for designing the control programs and reduce the economic losses globally. This literature review targeted for evaluating the infection rate of Neospora caninum in animals in Iran. Until April 2020, all of published documents in the main English and Persian-language databases were searched. A total number of 110 documents (English = 85 and Persian = 25) were extracted. Most of reports were sero-epidemiological studies using ELISA in Iranian cattle population. The range of Neospora infection was 3.8–76.2% in cattle, 0–54.6% in dogs, 0.9–9.9% in sheep, 6.2% in goats, 19.2–55.9% in buffaloes, 20–42.2% in horses, 52% in donkeys, 3.2–27% in camels, 14% and 19% in cats, and 0–20.4% in rodents. This rate in birds was 17.3% in chicken, 9.8% and 30.4% in pigeons, 2.8% and 3.7% in sparrows, and 9.9% in hooded crows. This is a comprehensive literature review on Neospora infection in Iran at the first time. The infection of N. caninum is widespread in Iran especially in dogs and cattle population. This review can provide baseline information for future research. Study on other hosts especially on wild and exotic animals is recommended for exact estimate of neosporosis in Iran. Investigations into molecular diagnosis and genotyping of N. caninum strains are also needed; this will be helpful for developing vaccines and finding the connection among wild and domestic cycles of disease. Education on the risk factors associated with N. caninum infection for is suggested farmers and rural public.

Deep learning workflow in radiology: a primer

Interest for deep learning in radiology has increased tremendously in the past decade due to the high achievable performance for various computer vision tasks such as detection, segmentation, classification, monitoring, and prediction. This article provides step-by-step practical guidance for conducting a project that involves deep learning in radiology, from defining specifications, to deployment and scaling. Specifically, the objectives of this article are to provide an overview of clinical use cases of deep learning, describe the composition of multi-disciplinary team, and summarize current approaches to patient, data, model, and hardware selection. Key ideas will be illustrated by examples from a prototypical project on imaging of colorectal liver metastasis. This article illustrates the workflow for liver lesion detection, segmentation, classification, monitoring, and prediction of tumor recurrence and patient survival. Challenges are discussed, including ethical considerations, cohorting, data collection, anonymization, and availability of expert annotations. The practical guidance may be adapted to any project that requires automated medical image analysis.

Magnetic resonance imaging characteristics in patients with histopathologically proven fibrous dysplasia-a systematic review

OBJECTIVE

To examine the demographics, lesion location, and characteristic magnetic resonance imaging (MRI) findings in patients with histopathologically proven fibrous dysplasia (FD).

MATERIALS AND METHODS

A systematic literature search of the MRI findings in patients with histologically proven FD was performed. Altogether, 76 articles with 136 patients were evaluated.

RESULTS

The mean age of the patients was 35.0 + - 18.5 years (range 1 month-75 years). Fifty-eight of the cases were females, 51 males, and in 27 gender was not defined. The most common locations were craniofacial (n = 55 (40%)), long bones (n = 31 (23%)), and spine (n = 24 (18%)). The monostotic form of FD was the most common. Signal intensities (SI) on T1-weighted images were predominantly hypointense (n = 46 (37%)). The SI was highly variable on T2-weighted images with hyperintensity being most common (n = 22 (18%)). Contrast enhancement was found in 75 (55%) FD patients. Secondary aneurysmal bone cysts (ABCs) and malignant transformation in patients without prior radiotherapy was found in some patients.

CONCLUSION

Current knowledge of the MRI findings in patients with FD is based mainly on case reports. SI in patients with FD is variable and contrast enhancement is common. FD may explain etiology of spinal bone tumor in some patients. FD with malignant transformation should be considered also in patients without prior radiotherapy. Further studies are needed to clarify if FD displays specific characteristics allowing it to be distinguished from other bone tumors.

Is there a role for hyperbaric oxygen therapy in the treatment of refractory wounds of rare etiology?

INTRODUCTION

Delayed wound healing indicates wounds that have failed to respond to more than 4-6 weeks of comprehensive wound care. Wounds with delayed healing are a major source of morbidity and a major cost to hospital and community healthcare providers. Hyperbaric oxygen therapy (HBOT) is a treatment designed to increase the supply of oxygen to wounds and has been applied to a variety of wound types. This article reviews the place of HBOT in the treatment of non-healing vasculitic, calcific uremic arteriolopathy (CUA), livedoid vasculopathy (LV), pyoderma gangrenosum (PG) ulcers.

METHODS

We searched electronic databases for research and review studies focused on HBOT for the treatment of delayed healing ulcers with rare etiologies. We excluded HBOT for ulcers reviewed elsewhere.

RESULTS

We included a total of three case series and four case reports including 63 participants. Most were related to severe, non-healing ulcers in patients with vasculitis, CUA, LV, and PG. There was some evidence that HBOT may improve the healing rate of wounds by increasing nitric oxide (NO) levels and the number of endothelial progenitor cells in the wounds. HBOT may also improve pain in these ulcers.

CONCLUSION

We recommend the establishment of comprehensive and detailed wound care registries to rapidly collect prospective data on the use of HBOT for these problem wounds. There is a strong case for appropriately powered, multi-centre randomized trials to establish the true efficacy and cost-effectiveness of HBOT especially for vasculitis ulcers that have not improved following immunosuppressive therapy.

Impending challenges of the burden of end-stage kidney disease in Australia

Sex and age-specific incidence rates of patients with treated end-stage kidney disease (ESKD) in Australia are comparable to those in European countries, but substantially lower compared with those in the United States, Canada and many Asian countries. The incidence rates of treated ESKD in Australia increase with advancing age; however, the incidence of ESKD is likely to be underestimated because a proportion of patients with ESKD (about 50%) remain untreated. Late referral to nephrologists has reduced over the past decade, temporally associated with improved ESKD recognition. However, late referral still occurs in one in five Australians with ESKD. One in two Australians with ESKD has diabetes, with up to 35% of cases directly attributed to diabetes. Mortality rates for patients with ESKD remain substantially higher compared with the age-matched general population, although there has been a significant improvement in survival over time. Cardiovascular disease and cancer are the two most common causes of death in patients with ESKD.

Gartner's duct cysts: a review of surgical management and a new technique using fluorescein dye

INTRODUCTION AND HYPOTHESIS

Gartner's duct cysts (GDC) are benign lesions that may become symptomatic, leading to surgical intervention. There is no standard surgical technique for management of GDC. This article provides a comprehensive review of surgical the management of GDC. We also present a new technique using fluorescein dye to help delineate GDC walls and facilitate complete cyst excision.

METHODS

We conducted a PubMed search for English-language articles without a defined time range. The search combined subject headings, title, abstract, and text words relating to Gartner duct cysts. Articles describing surgical management of GDC were included. Exclusion criteria included inadequate diagnosis of GDC, infected cysts, nonsurgical management, or article unavailable for interlibrary loan. A novel approach using intra-cyst fluorescein dye injection is described.

RESULTS

Two hundred sixty-seven articles were identified via PubMed, and 34 articles were included in the review based on eligibility criteria. Concomitant genitourinary malformations occurred in 19 of the 92 surgically managed patients. Surgical techniques included cyst excision (50 patients), tetracycline injection following aspiration (15), marsupialization (14), unroofing/partial excision (9), and puncture/evacuation (4). Recurrences occurred in 4, 1, 0, 0, and 1 patient, respectively. One patient underwent uncomplicated fluorescein dye-assisted cyst excision with no recurrence 30 months post-procedure.

CONCLUSIONS

The low incidence of GDCs necessitating surgical intervention has resulted in a lack of standard surgical technique, especially in patients with concurrent genitourinary malformations. Utilizing fluorescein dye provides a surgical method that can help confirm the absence of urologic involvement as well as facilitate precise excision of GDC.

Adult cervical deformity: radiographic and osteotomy classifications

Cervical spine deformity represents a broad spectrum of pathologies that are both complex in etiology and debilitating towards quality of life for patients. Despite advances in the understanding of drivers and outcomes of cervical spine deformity, only one classification system and one system of nomenclature for osteotomy techniques currently exist. Moreover, there is a lack of standardization regarding the indications for each technique. This article reviews the adult cervical deformity (ACD) and current classification and nomenclature for osteotomy techniques, highlighting the need for further work to develop a unified approach for each case and improve communication amongst the spine community with respect to ACD.

Antiphospholipid syndrome: a clinical review

Antiphospholipid syndrome is characterised by recurrent thrombosis (arterial, venous, microvascular) and/or pregnancy complications in the presence of persistent antiphospholipid antibodies (lupus anticoagulant, anti-β2-glycoprotein 1 and anticardiolipin). It can be a primary disease or associated with another autoimmune disease (especially systemic lupus erythematosis). Testing for antiphospholipid antibodies should be considered in patients < 50 years of age with unprovoked venous or arterial thromboembolism, thrombosis at unusual sites or pregnancy complications. The mainstay of treatment is antithrombotic therapy and recommendations vary based on arterial, venous or pregnancy complications. If associated with systemic lupus erythematosis, hydroxychloroquine is recommended both as primary and secondary prophylaxis. Antithrombotic treatment is gold standard and effective.

Systematic review on the effects of medication under hyperbaric conditions: consequences for the diver

BACKGROUND

Physiological changes are induced by immersion, swimming and using diving equipment. Divers must be fit to dive. Using medication may impact the capacity to adapt to hyperbaric conditions. The aim of this systematic review is to assess the interaction of diving/hyperbaric conditions and medication and to provide basic heuristics to support decision making regarding fitness to dive in medicated divers.

METHODS

This was a systematic review of human and animal studies of medications in the hyperbaric environment. Studies were subdivided into those describing a medication/hyperbaric environment interaction and those concerned with prevention of diving disorders. Studies without a relation to diving with compressed air, and those concerning oxygen toxicity, hyperbaric oxygen therapy or the treatment of decompression sickness were excluded.

RESULTS

Forty-four studies matched the inclusion criteria. Animal studies revealed that diazepam and valproate gave limited protection against the onset of the high-pressure neurological syndrome. Lithium had a protective effect against nitrogen-narcosis and losartan reduced cardiac changes in repetitive diving. Human studies showed no beneficial or dangerous pressure-related interactions. In prevention of diving disorders, pseudoephedrine reduced otic barotrauma, vitamins C and E reduced endothelial dysfunction after bounce diving and hepatic oxidative stress in saturation diving.

DISCUSSION AND CONCLUSIONS

Animal studies revealed that psycho-pharmaceuticals can limit the onset of neurologic symptoms and cardiovascular protective drugs might add a potential protective effect against decompression sickness. No evidence of significant risks due to changes in pharmacologic mechanisms were revealed and most medication is not a contraindication to diving. For improving decision making in prescribing medicine for recreational and occupational divers and to enhance safety by increasing our understanding of pharmacology in hyperbaric conditions, future research should focus on controlled human studies.

Diving and attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) is a psychiatric condition that affects attention, concentration, impulse control and awareness. Not only these symptoms, but also the medications used to treat ADHD (psychostimulants) pose a risk to both the diver and his or her buddy. This article presents guidelines for recreational diving in combination with ADHD and psychostimulants. These guidelines are based solely on 'expert' opinion and were adopted at a meeting of the Dutch Association for Diving Medicine in 2017.

Rhinologic and oral-maxillofacial complications from scuba diving: a systematic review with recommendations

Rhinologic and oral maxillofacial complications from scuba diving are common, representing approximately 35% of head and neck pathology related to diving. We performed a systematic and comprehensive literature review on the pathophysiology, diagnosis, and treatment of rhinologic and oral maxillofacial pathology related to diving. This included complications due to sinus barotrauma, barodontalgia, odontocrexis, temporomandibular joint dysfunction, partially dentulous patients, and considerations for patients following major head and neck surgery. Of 113 papers accessed, 32 were included in the final synthesis. We created a succinct summary on each topic that should inform clinical decision making by otolaryngologists, dive medicine specialists and primary care providers when faced with pathology of these anatomic sub-sites.

Vibration and bubbles: a systematic review of the effects of helicopter retrieval on injured divers

INTRODUCTION

Vibration from a helicopter during aeromedical retrieval of divers may increase venous gas emboli (VGE) production, evolution or distribution, potentially worsening the patient's condition.

AIM

To review the literature surrounding the helicopter transport of injured divers and establish if vibration contributes to increased VGE.

METHOD

A systematic literature search of key databases was conducted to identify articles investigating vibration and bubbles during helicopter retrieval of divers. Level of evidence was graded using the Oxford Centre for Evidence-Based Medicine guidelines. A modified quality assessment tool for studies with diverse designs (QATSDD) was used to assess the overall quality of evidence.

RESULTS

Seven studies were included in the review. An in vitro research paper provided some evidence of bubble formation with gas supersaturation and vibration. Only one prospective intervention study was identified which examined the effect of vibration on VGE formation. Bubble duration was used to quantify VGE load with no difference found between the vibration and non-vibration time periods. This study was published in 1980 and technological advances since that time suggest cautious interpretation of the results. The remaining studies were retrospective chart reviews of helicopter retrieval of divers. Mode of transport, altitude exposure, oxygen and intravenous fluids use were examined.

CONCLUSION

There is some physical evidence that vibration leads to bubble formation although there is a paucity of research on the specific effects of helicopter vibration and VGE in divers. Technological advances have led to improved assessment of VGE in divers and will aid in further research.

Pancreatic necrosis: Complications and changing trend of treatment

Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.

Hypertension after Kidney Transplantation: Clinical Significance and Therapeutical Aspects

Most of the kidney transplanted patients develop arterial hypertension after renal transplantation. Together with very well-known and usual risk factors, post-transplant hypertension contributes to the whole cardiovascular morbidity and mortality in the kidney transplant population. The reasons of post-transplant hypertension are factors related to donors and recipients, immunosuppressive therapy like Calcineurin Inhibitors (CNI) and surgery procedures (stenosis and kinking of the renal artery and ureteral obstruction). According to Eighth National Committee (JNC 8) recommendations, blood pressure > 140/90 mmHg is considered as hypertension. The usual antihypertensive drugs used for the control of hypertension are Calcium channel blockers (CCB), Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin -II receptor blockers (ARB), B- blockers and diuretics. Follow the KDIGO guidelines the target blood pressure < 140/90 mmHg for patients without proteinuria and < 125/75 mmHg in patients with proteinuria is recommended. Better control of post-transplant hypertension improves the long-term graft and patient's survival.

Ruptured Sinus of Valsalva Aneurysm and Gerbode Defects: Patient and Procedural Selection: the Key to Optimising Outcomes

PURPOSE OF REVIEW

In this review, we reflect on the historical background, clinical features and imaging techniques used to assess Gerbode defects and sinus of Valsalva aneurysms. We aim to review the evolution of treatment strategies and the progression towards less invasive management for these conditions.

RECENT FINDINGS

While transthoracic echocardiography is often diagnostic, transesophageal echocardiography (2D and 3D) has improved our understanding of these defects and allowed us to more accurately define their anatomy. Cardiac MRI provides improved assessment of the physiological impact of defects by quantifying shunt volume. Transcatheter techniques are currently vying with surgery as the mainstay of treatment. New insights are being discovered regarding diagnostic modalities and treatment pathways. Defining criteria for patient selection for catheter or surgical therapy is essential when deciding on the optimum intervention for the individual patient.

Writing a review article - Are you making these mistakes?

An explosion of scientific publications over the last decades has increased the need for review articles: Carefully crafted scientific review articles can provide the novice reader with an overview of a new subject and provide the expert with a synthesis of scientific evidence, proof of reproducibility of published data and pooled estimates of common truth through meta-analyses. Unfortunately, while there are ample presentations and published guidelines for the preparation of scientific articles available, detailed information about how to properly prepare scientific review articles is relatively scarce. This perspective summarizes possible mistakes that can lead to misinformation in scientific review articles with the goal to help authors to improve the scientific contribution of their review article and thereby, increase the respective value of these articles for the scientific community.

Immunotherapy for hepatocellular carcinoma patients: is it ready for prime time?

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the second most common cause of cancer death worldwide. Current treatment options for patients with intermediate and advanced HCC are limited, and there is an unmet need for novel therapeutic approaches. HCC is an attractive target for immunomodulation therapy, since it arises in an inflammatory milieu due to hepatitis B and C infections and cirrhosis. However, a major barrier to the development and success of immunotherapy in patients with HCC is the liver's inherent immunosuppressive function. Recent advances in the field of cancer immunology allowed further characterization of immune cell subsets and function, and created new opportunities for therapeutic modulation of the immune system. In this review, we present the different immune cell subsets involved in potential immune modulation of HCC, discuss their function and clinical relevance, review the variety of immune therapeutic agents currently under investigation in clinical trials, and outline future research directions.

Epidemiology of hepatocellular carcinoma: target population for surveillance and diagnosis

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the second leading cause of cancer mortality worldwide. Incidence rates of liver cancer vary widely between geographic regions and are highest in Eastern Asia and sub-Saharan Africa. In the United States, the incidence of HCC has increased since the 1980s. HCC detection at an early stage through surveillance and curative therapy has considerably improved the 5-year survival. Therefore, medical societies advocate systematic screening and surveillance of target populations at particularly high risk for developing HCC to facilitate early-stage detection. Risk factors for HCC include cirrhosis, chronic infection with hepatitis B virus (HBV), hepatitis C virus (HCV), excess alcohol consumption, non-alcoholic fatty liver disease, family history of HCC, obesity, type 2 diabetes mellitus, and smoking. Medical societies utilize risk estimates to define target patient populations in which imaging surveillance is recommended (risk above threshold) or in which the benefits of surveillance are uncertain (risk unknown or below threshold). All medical societies currently recommend screening and surveillance in patients with cirrhosis and subsets of patients with chronic HBV; some societies also include patients with stage 3 fibrosis due to HCV as well as additional groups. Thus, target population definitions vary between regions, reflecting cultural, demographic, economic, healthcare priority, and biological differences. The Liver Imaging Reporting and Data System (LI-RADS) defines different patient populations for surveillance and for diagnosis and staging. We also discuss general trends pertaining to geographic region, age, gender, ethnicity, impact of surveillance on survival, mortality, and future trends.

LI-RADS and transplantation for hepatocellular carcinoma

Patients with hepatocellular carcinoma (HCC) may be eligible for liver transplantation. Liver transplant candidates with HCC compete for the same deceased donor organs as those without HCC. These scarce organs must be allocated fairly and justly to those who will benefit most. Unlike most other cancers, HCC is often diagnosed noninvasively by imaging without biopsy confirmation. Therefore, radiologists play an important role in diagnosing definite HCC (i.e., LR-5 category) that counts toward staging and determination of liver transplant eligibility. This review explains the conversion of LI-RADS observation categories to organ procurement and transplantation network classes, illustrates the radiologic T-staging systems, reviews selection criteria for liver transplant eligibility, and discusses prioritization of liver transplant candidates with HCC. In addition, this review summarizes imaging requirements, including contrast agents accepted, minimum specifications for dynamic CT or MRI of the liver, and modalities accepted for assessment of extrahepatic spread or metastatic disease in liver transplant candidates with HCC.