Past, Present, and Future Perspectives on the Systemic Therapy for Advanced Hepatocellular Carcinoma (HCC) — A Comprehensive Review

Hepatocellular carcinoma (HCC) is the fifth most frequent cancer, the third leading cause of cancer-related mortality, and the first leading cause of death in patients with cirrhosis. Management of primary locally advanced, inoperable, recurrent or metastatic HCC is very challenging and continues to be a topic of controversy. Herein, we shed light on the past, present, and future perspectives on the systemic therapy (hormonal therapy, cytotoxic chemotherapy, and novel molecularly targeted therapy) for management of patients with advanced HCC

Antimicrobial impact of a propolis/PVA/chitosan composite and its prospective application against methicillin resistance bacterial infection

Seriously damaged skin could be infected by methicillin-resistant bacteria, which delays restoration. Propolis has bioactivity linked with its minor components, such as antimicrobials and antioxidants. Active sites in polyvinyl alcohol (PVA) and chitosan (CS) can enhance the nano-loading of natural extracts with activity amelioration. Korean propolis extract (KPE) loading to a nanocomposite possibly enhances its antimicrobial and anti-inflammatory potency. Composites were formed using two PVA/CS structures (1:1; 2:1), and their skin-application appropriateness was determined by mechanical properties, moisture content, water activity, and color. The composite of PVA/CS (1:1) was more practicable for KPE-loading. Increasing KPE concentrations (50, 100, 150, and 200 ng/mL) alters composite bioactivity measured by Fourier transmission infrared (FT-IR). Antibacterial potency of 200 ng KPE/mL was the most effective concentration, followed by 150 ng KPE/mL, against Staphylococcus aureus (MRSA) and Clostridium perfringens. The composite activity was measured as minimum inhibition (MIC) and minimum bacterial concentrations (MBC). At 200 ng KPE/mL, MIC and MBC against MRSA were 14.93 ± 1.21 and 20.21 ± 1.97 mg composite/mL, respectively. Significant inhibition was also recorded for antibiofilm formation, where MRSA growth was not detected after 4 hours of time intervals to the stainless-steel coupon. Compared to planktonic bacteria, the formed barrier of PVA/CS restrained the biofilm matrix formation and supported KPE antimicrobial. The impact of inhibition against biofilm formation depends on two parallel mechanisms (PVA barrier with hydrogen bonds, besides nano-KPE particle penetration into bacterial cells). The KPE-composite application to rats’ wounds shows significantly reduced MRSA infection. The results demonstrate the capability of KPE composite in reducing infection, healing correctly, and restoring hair. The wound swabbed test emphasizes this capacity, in which bacterial growth rate restriction was evaluated using a plate count assay. The results recommended 150 ng KPE/mL loading into CS/PVA (1:1) as an effective anti-pathogenic treatment, particularly against the MRSA infection of wounds

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021

Background: Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods: Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings: Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity. Interpretation: No country to date has successfully curbed the rising rates of adult overweight and obesity. Without immediate and effective intervention, overweight and obesity will continue to increase globally. Particularly in Asia and Africa, driven by growing populations, the number of individuals with overweight and obesity is forecast to rise substantially. These regions will face a considerable increase in obesity-related disease burden. Merely acknowledging obesity as a global health issue would be negligent on the part of global health and public health practitioners; more aggressive and targeted measures are required to address this crisis, as obesity is one of the foremost avertible risks to health now and in the future and poses an unparalleled threat of premature disease and death at local, national, and global levels. Funding: Bill & Melinda Gates Foundation

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Pediatrics Ewing’s Sarcoma of the Sinonasal Tract: A Case Report and Literature Review

Ewing’s sarcoma (ES) is a highly malignant, small, round cell tumor that originates from the primitive neuroectodermal cells. Primary ES commonly occurs in early childhood or adolescence. It may present with skeletal and extraskeletal forms. The extraskeletal form is rarely encountered in the head and neck region and is extremely rare in the sinonasal tract. This is a case report of sinonasal ES in a 13-year-old female patient who presented with a 7-month history of right nasal obstruction, anosmia, intermittent epistaxis, snoring, and hearing loss. Clinical examination revealed a right nasal mass pushing the septum to the left side and extending to the nasopharynx. Endoscopic biopsy and histopathological analysis showed a small blue cell tumor suggestive of ES. The patient was treated with surgery, radiotherapy, and chemotherapy. After a follow-up of 5 years, the patient remains recurrence-free with excellent functional status and quality of life

Synthesis of LiNi_0.5Mn_1.5O₄ for Class 5V Batteries Using a Microwave Heating Method

Introduction Lithium-ion batteries are the main power source for most portable electronic devises. The faster the technologies develop the greater the worldwide demand for batteries with higher performance grows. The transition to new challenging applications such as hybrid and electrical vehicles require going beyond what the present state of batteries can achieve density wise. One of the solutions for achieving high energy density is by using cathode materials with high voltage output, such as lithium nickel manganese oxide LiNi0.5Mn1.5O4 (LNMO). It is considered as one of the most promising cathode materials for lithium-ion batteries due to its good rate capability, cycle performance and most importantly its high discharge plateau of about 4.7V [1]. Recently, many methods have been reported for synthesizing LNMO, which include solid-state reaction, sol-gel technique and precipitation [2]. However, we developed a unique synthetic method by using microwaves, which is a promising method of preparation [3, 4]. In this technique, unlike other heating methods the microwave heating can affect higher temperatures inside the product than on its surface. Also due to the heating of the material throughout the whole volume, the high uniformity of warming is reached as well as more precise temperature regulation. Overheating of certain parts of the product can be better prevented this way. This method is utilized for mass cathode material production at low energy cost. In this research, we report the synthesis of LNMO using our microwave heating method. Precursor material was prepared using a self-reaction method that was previously shown to be suitable for the preparation of complex metal oxide powders. Experimental The LNMO precursor was prepared by dissolving Lithium Nitrate, Nickel (II) Nitrate Hexahydrate and Manganese (II) Nitrate Hexahydrate with a mol ratio of (0.1:0.05:0.15) in distilled water and mixed using a stone mortar to form a mixed aqueous solution. The solution was then heated up in a microwave with various conditions such as time and oxygen/air flow. The product was grinded and left to dry before various characterization tests were preformed. To clarify the influence of the many factors applied, the prepared materials were characterized by X-ray diffraction, Fourier transformation infrared spectroscopy, scanning electron microscopy and their electrochemical properties. To perform the electrochemical measurements, LNMO was mixed with various amounts of the conductive material, acetylene black (AB), and the adhesive material, polytetrafluoroethylene (PTFE), to determine the right amount with the best results. The material was then rolled to form a thin sheet and cut into 6mm diameter discs to make the positive electrode. For the battery tests, the metal cell was assembled in an argon atmosphere with the LNMO cathode, the anode as lithium metal and the electrolyte 1M LiPF6 in a 1:1 solvent mixture of (EC)/(DMC). The current rate was 20mAg-1 with cut-off voltages of 3 and 4.9V. Results and discussion The results revealed that spinel LiNi0.5Mn1.5O4 powders can be directly synthesized by microwave heating. The X-ray diffraction patterns of the product showed more or less to have a single-phase spinal structure. With the increase in heating time, the samples showed rather sharper diffractions. The SEM photographs showed that the powders are composed of small particles and regular particles whose morphologies are almost the same as for the spinals reported in other papers [2, 5]. In the electrochemical analysis, the discharge curve had two plateaus, one with a high potential at the 4.7 V region, and the other is in the 4 V region. The plateau at 4.7 V has been ascribed to the two-steps (Ni4+/Ni3+, Ni3+/Ni2+) redox reactions [6]. The plateau at 4V is due to the presence of residual amount of Mn3+ in the spinel [6]. Reference [1] T. Zheng and J. R. Dahn: Phys. Rev. B Vol. 56 (1997), p.3800 [2] Y. Sun, Y. Yang, X. Zhao and H. Shao: Electrochim. Acta Vol. 56 (2011), p.5934 [3] M. Higuchi, K. Katayama, Y. Azuma, M. Yukawa and M. Suhara: J. Power Sources Vol.119-121 (2003), p.258 [4] M. Higuchi, K. Suzuki, K. Katayama, T. Nakamura, A. Kagohashi, A. Kinoshita and H. Suzuki: Key Eng. Mater. Vol. 445 (2010), p.113 [5] G.B. Zhong, Y.Y. Wang, Z.C. Zhang and C.H. Chen: Electrochim. Acta Vol. 56 (2011), p.6554 [6] M. Kunduraci and G.G. Amatucci: J. Power Sources Vol. 165 (2007), p.359</jats:p