Search Results (357)

Hemorrhoidal disease remains a prevalent yet often overlooked condition, affecting millions worldwide and imposing a substantial healthcare burden. Despite the availability of multiple treatment options, gaps persist in patient education, early symptom recognition, and optimal treatment selection. Recent advancements are evolving the pharmacist’s role in hemorrhoid management beyond traditional over-the-counter (OTC) and prescription approaches. The 2024 American Society of Colon and Rectal Surgeons (ASCRS) guidelines introduce updates on the use of phlebotonics, a class of venoactive drugs gaining recognition for their role in symptom management, yet largely underutilized in U.S. clinical practice. In parallel, novel clinical tools are reshaping how pharmacists engage in assessment and care. The integration of digital decision-support platforms and structured evaluation algorithms now empowers them to systematically evaluate symptoms, identify red flag signs, and optimize patient triage. These tools reduce diagnostic variability and improve decision-making accuracy. Given their accessibility and trusted role in frontline healthcare, pharmacists are well-positioned to bridge these critical gaps by adopting emerging treatment recommendations, leveraging algorithm-driven assessments, and reinforcing best practices in patient education and referral. This narrative review aims to equip pharmacists with updated insights into evidence-based hemorrhoid management strategies and provide them with structured assessment algorithms to standardize symptom evaluation and treatment pathways. By integrating these innovations, pharmacists can enhance treatment outcomes, promote patient safety, and contribute to improved quality of life (QoL) for individuals suffering from hemorrhoidal disease. Full article

Background: South Asian Americans (SAA) are one of the fastest-growing immigrant groups in the U.S. and face significant health disparities, particularly regarding chronic diseases like diabetes, hypertension, and cardiovascular disease. Dietary patterns play a crucial role in these disparities, with acculturation to Western diets linked to poorer health outcomes. Despite this, the impact of food insecurity on dietary habits among SAAs remains underexplored. This study aims to examine the availability, cost, and quality of ethnic food items and how food insecurity influences dietary practices in Southern California’s SAA population. Methods: The study was conducted in San Bernardino County, California, with field data collection focused on five South Asian ethnicity-specific grocery stores and three Western grocery stores. We assessed the availability and cost of key ingredients for commonly prepared SAA dishes. Additionally, focus group interviews were held with South Asian immigrants to understand food insecurity challenges and dietary adaptations. Results: The study found significant disparities in food availability and cost between SAA-ethnic grocery stores and Western stores. SAA stores were less accessible and more widely dispersed, with an average distance of 10 miles between them. While ingredients like ginger paste and cumin powder were available in both types of stores, items such as ghee, fenugreek seeds, and black gram were harder to find in Western stores. Focus group participants noted that ethnic foods, especially vegetarian ingredients, were more expensive than Western alternatives, leading many to substitute traditional meals with cheaper, less nutritious options. Participants also raised concerns about the poor quality of items in ethnic stores, such as expired produce, which further limited their food choices. Conclusions: Food insecurity, driven by limited availability, high cost, and poor quality of ethnic foods, poses significant challenges to the SAA community’s diet and health. Addressing these barriers could improve food security and health outcomes among SAA immigrants. Full article

Thyroid cancer (TC) is the most common endocrine malignancy, with a rising global incidence. In Ecuador, TC rates are among the highest worldwide. Generally, fine-needle aspiration (FNA) remains the standard diagnostic tool; however, due to its limitations, alternative or complementary approaches are required. In this context, liquid biopsy, particularly circulating tumor DNA (ctDNA), offers a promising, minimally invasive option for tumor genotyping. Objective: This study evaluated the concordance between genetic variants identified in ctDNA and tumor tissue. Thirty-six women with papillary thyroid cancer were included. Tumor tissue and blood samples were collected, and DNA was extracted. Next-Generation Sequencing (NGS) using the TruSight Tumor 15 panel identified genetic variants in both ctDNA and tumor DNA. Variant pathogenicity was assessed following ACMG guidelines. Genetic ancestry was determined using Ancestry Informative Markers (AIMs). A total of 71 cancer-associated variants were detected, with 81.69% concordance between tumor DNA and ctDNA. TP53 was the most frequently mutated gene. While most pathogenic variants were found in tumor tissue, some variants appeared exclusively in ctDNA samples on specific patients, suggesting tumor heterogeneity. Ancestry analysis revealed a predominant Native American component (62.4%). Liquid biopsy demonstrates high concordance with tumor tissue analysis and holds potential as a complementary diagnostic tool for thyroid cancer. However, challenges such as low ctDNA yield and underrepresentation in genetic databases highlight the need for improved protocols and increased inclusion of admixed populations in genomic studies. Full article

A high-throughput sequencing-based grapevine metagenomic survey was conducted across all grape-growing Canadian provinces (British Columbia, Ontario, Nova Scotia, and Québec) with the objective of better understanding the grapevine virome composition. In total, 310 composite grapevine samples representing nine Vitis vinifera red; five V. vinifera white; seven American–French red; and five white hybrid cultivars were analyzed. dsRNA, enriched using two different methods, was used as the starting material and source of viral nucleic acids in HTS. The virome status on the distribution and incidence in different regions and grapevine cultivars is addressed. Results from this study revealed the presence of 20 viruses and 3 viroids in the samples tested. Twelve viruses, which are in the regulated viruses list under grapevine certification, were identified in this survey. The major viruses detected in this survey and their incidence rates are GRSPaV (26% to 100%), GLRaV-2 (1% to 18%), GLRaV-3 (15% to 63%), GRVFV (0% to 52%), GRGV (0% to 52%), GPGV (3.3% to 77%), GFkV (1.5% to 31.6%), and GRBV (0% to 19.4%). This survey is the first comprehensive virome study using viral dsRNA and a metagenomics approach on grapevine samples from the British Columbia, Ontario, Nova Scotia, and Quebec provinces in Canada. Results from this survey highlight the grapevine virome distribution across four major grapevine-growing regions and their cultivars. The outcome of this survey underlines the need for strengthening current management options to mitigate the impact of virus spread, and the implementation of a domestic grapevine clean plant program to improve the sanitary status of the grapevine ecosystem. Full article

Background/Objectives: Robot-assisted radical cystectomy (RARC) has become the primary approach for treating bladder cancer, replacing the traditional open procedure. The robotic approach, when combined with ureterocutaneostomy (UCS), offers significant advantages for octogenarians, who are at increased risk for perioperative complications. Methods: This observational, prospective, multicenter analysis is based on data from the Italian Radical Cystectomy Registry (RIC), collected from January 2017 to June 2020 across 28 major urological centers in Italy. We analyzed consecutive male and female patients undergoing radical cystectomy (RC) and urinary diversion via the open, laparoscopic, or robot-assisted technique. Inclusion criteria: patients aged 80 years or older, with a WHO Performance Status (PS) of 2–3, an American Society of Anesthesiologist score ≥3, a Charlson Comorbidity Index (CCI) ≥ 4, and a glomerular filtration rate (GFR) <60 mL/min. Results: A total of 128 consecutive patients were included: 41 underwent RARC with UCS (Group 1), 65 open RC (ORC) with UCS (Group 2), and 22 laparoscopic RC (LRC) with UCS (Group 3). The cystectomy operative time was longer in robotic surgeries, while the lymph node dissection time was shorter. RARC with UCS showed statistically significant advantages in terms of lower median estimated blood loss (EBL), transfusion rate, and length of hospital stay (LOS) compared to open and laparoscopic procedures. Intra- and postoperative complications were also lower in the RARC groups. Conclusions: Robotic cystectomy in high-volume referral centers (≥20 cystectomies per year) provides the best outcome for fragile patients. Beyond addressing the baseline pathology, RARC with UCS may represent a leading option, offering oncological control while reducing complications in this vulnerable age group. Full article

Background and Objectives: International guidelines differ on short-term (4-week) oral anticoagulation (OAC) indication after acute cardioversion for recent-onset atrial fibrillation (AF < 12–48 h) in low-risk patients (CHA₂DS₂-VA = 0). While Canadian and Chinese guidelines recommend OAC for all, European, Australian and New Zealand, and American guidelines state that such treatment is optional due to the absence of high-quality evidence supporting its indication in this specific scenario. This study aimed to assess physicians’ management of a simple clinical case at an international level, focusing on how they balance ischemic and bleeding risks in a setting lacking any strong evidence-based recommendations. Materials and Methods: Six different AF guidelines were evaluated regarding the recommendation for and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed with Google Forms 2024 (Mountain View, CA, USA) and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France, and Canada. Results: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher’s Exact Test p = 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to cardioversion being performed more often in Europe vs. Canada (p = 0.006) and in long-term rhythm control, with first-line pulmonary vein isolation (PVI) being offered more frequently by European cardiologists (p = 0.013). No statistically significant association was found regarding guideline adherence for OAC administration (p = 0.120). Conclusions: The real-world antithrombotic management of low-risk (CHA₂DS₂-VA = 0), acutely cardioverted AF patients varies significantly among different healthcare systems. Particularly in cardiology departments, reducing the time limit for safely not prescribing OAC to < 12 h, ensuring local access to direct oral anticoagulants (DOACs) and considering regional stroke risk profiles, as well as actively preventing haemorrhage in patients receiving short-term OAC could all limit cardioversion-related complications in this low-risk population. Full article

Addressing the urgent need to decarbonise aviation and valorise agricultural waste, this paper investigates the production of Sustainable Aviation Fuel (SAF) from corn stover. A preliminary evaluation based on a literature review indicates that among various conversion technologies, fast pyrolysis (FP) emerged as the most promising option, offering the highest fuel yield (22.5%) among various pathways, a competitive potential minimum fuel selling price (MFSP) of 1.78 USD/L, and significant greenhouse gas savings of up to 76%. Leveraging Aspen Plus simulation, SAF production via FP was rigorously designed and optimised, focusing on the heat integration strategy within the process to minimise utility consumption and ultimately the total cost. Consequently, the produced fuel exceeded the American Society for Testing and Materials (ASTM) limit for the final boiling point, rendering it unsuitable as a standalone jet fuel. Nevertheless, it achieves regulatory compliance when blended at a rate of up to 10% with conventional jet fuel, marking a practical route for early adoption. Energy optimisation through pinch analysis integrated four hot–cold stream pairs, eliminating external heating, reducing cooling needs by 55%, and improving sustainability and efficiency. Economic analysis revealed that while heat integration slashed utility costs by 84%, the MFSP only decreased slightly from 2.35 USD/L to 2.29 USD/L due to unchanging material costs. Sensitivity analysis confirmed that hydrogen, catalyst, and feedstock pricing are the most influential variables, suggesting targeted reductions could push the MFSP below 2 USD/L. In summary, this work underscores the technical and economic viability of corn stover-derived SAF, providing a promising pathway for sustainable aviation and waste valorisation. While current limitations restrict fuel quality during full substitution, the results affirm the feasibility of SAF blending and present a scalable, low-carbon pathway for future development. Full article

Vegetable intake among military Service Members (SMs) is well below public health guidelines, with only 12.9% meeting the Dietary Guidelines for Americans (DGAs). Low vegetable consumption negatively impacts diet quality as measured by the Healthy Eating Index (HEI), and poses risks to health and performance. Given the high physical and mental demands of military life, improving diet quality, including through increased vegetable intake, is crucial for optimizing health and readiness. Providing meal kits may help improve vegetable intake by reducing access-related barriers for SMs living or working on a military base. Furthermore, the addition of spices and herbs is a readily modifiable accompanying approach to address taste-related barriers and increase intake that has shown promise in other populations with poor diet quality. Background/Objectives: This study aimed to evaluate whether heat-and-serve meal kits with spices and herbs could increase vegetable intake and liking among active-duty SM by simultaneously targeting barriers to healthy eating and modifiable sensory factors. Methods: Conducted at Naval Support Activity Bethesda, the study randomly distributed heat-and-serve meal kits (n = 400) featuring either spiced (n = 200) or plain versions (n = 200) of four vegetables (broccoli, carrots, cauliflower, and kale). Each kit contained a quick response (QR) code for participants to upload post-consumption photos and rate vegetable liking on a nine-point Likert scale. Food photography (SmartIntake^®) was used to estimate vegetable consumption. Paired t-tests were used to determine differences between the intake of plain and spiced vegetables. Results: Intake of the heat-and-serve vegetables was very high for both the spiced and plain preparations (1.73 out of 2 cups, 87%). There was minimal difference (p = 0.87) between the consumption of spiced (1.75 cups) and plain (1.725 cups) vegetables, suggesting that both were well accepted. Overall, convenient and accessible meal options, alongside sensory-driven strategies, appear to improve some barriers to vegetable consumption in SM populations. Conclusions: Future studies should explore long-term outcomes and adaptability across different military environments, while considering additional factors, including convenience and time constraints, that influence dietary choices in the military. Full article

Background/objectives: Social media has significantly enhanced access to medical knowledge by enabling rapid information sharing. With YouTube being the second-most popular website, we intended to evaluate the quality of its content as a source of information for patients and relatives for information about cerebral palsy. Methods: The first 30 videos for search terms “Cerebral palsy”, “Spastic cerebral palsy”, “Dyskinetic cerebral palsy”, “Worster-Drought syndrome”, and “Ataxic cerebral palsy” were selected for inquiry. Out of 150 films, a total of 83 were assessed with a mixed method approach by two independent raters utilizing evidence-based quality scales such as Quality Criteria for Consumer Health Information (DISCERN), the Journal of the American Medical Association instrument (JAMA), and the Global Quality Score (GQS). Furthermore, audience engagement was analyzed, and the Video Power Index (VPI) was calculated for each video. Results: The mean total DISCERN score excluding the final question (subjective assessment of the video) was 30.5 ± 8.7 (out of 75 points), implying that the quality of the videos was poor. The global JAMA score was 2.36 ± 0.57 between the raters. The mean GQS score reached 2.57 ± 0.78. The videos had statistically higher DISCERN scores when they included treatment options, risk factors, anatomy, definition, information for doctors, epidemiology, doctor as a speaker, and patient experience. Conclusions: YouTube seems to be a poor source of information for patients and relatives on cerebral palsy. The analysis can contribute to creating more engaging, holistic, and informative videos regarding this topic. Full article

In this paper, we present a fast and accurate numerical approach applied to specific American-style derivatives, namely American power call and put options, whose main feature is that the underlying asset is raised to a power. The study is set in the Black–Scholes framework, and we consider continuously paying dividends assets and arbitrary positive values for the power. It is important to note that although a log-normal process raised to a power is again log-normal, the resulting change in variables may lead to a negative dividend rate, and this case remains largely understudied in the literature. We derive closed-form formulas for the perpetual options’ optimal boundaries and for the fair prices. For finite maturities, we approximate the optimal boundary using some first-hitting properties of the Brownian motion. As a consequence, we obtain the option price quickly and with relatively high accuracy—the error is at the third decimal position. We further provide a comprehensive analysis of the impact of the parameters on the options’ value, and discuss ordinary European and American capped options. Various numerical examples are provided. Full article

In this paper, we study perpetual American put options with a generalized standard put payoff and establish sufficient conditions for the existence and uniqueness of the solution to the associated pricing problem. As a key tool, we express the Black–Scholes operator in terms of elasticity. This formulation enables us to demonstrate that the considered pricing problem admits a unique solution when the payoff function exhibits strictly decreasing elasticity with respect to the underlying asset. Furthermore, this approach allows us to derive closed-form solutions for option pricing. Full article

Background/Objectives: Colorectal cancer (CRC) is the most common gastrointestinal (GI) malignancy, the second leading cause of cancer-related mortality, and the third most prevalent tumor. Around 20% of cases are metastatic or inoperable at diagnosis, often requiring palliative treatment, which may not be feasible in frail patients. Calcium-electroporation, a less invasive alternative, induces cell death via apoptosis, necrosis, and pyroptosis. This study is the first in the United Kingdom to evaluate the efficacy and safety of endoscopic calcium-electroporation in palliating distal CRC. Methods: Frail patients with inoperable left-sided CRC were included. The diagnosis and staging followed standard guidelines, while frailty was assessed using the performance status (PFS), Charlson comorbidity index (CCI), and American Society of Anesthesiologists (ASA) score. Calcium electroporation was performed via a flexible endoscopy usually under sedation, with symptom relief, quality of life (QoL), survival, and adverse events (AE) monitored. Results: Sixteen patients (median age 84.5) underwent 36 treatments with electroporation over 28 months (November 2022 to March 2025). The incidence of common symptoms was rectal bleeding (75%), constipation (25%), and pain (75%). Nine patients had metastases and three had failed conventional treatments. Symptomatic relief and an improved QoL occurred in 86.7%, with transfusion/iron infusion needs reduced by 91.7%. The median cancer-specific survival was 10 months, with a 94% survival rate. No device-related AE was recorded. One patient died after 11 months due to disease progression while two patients passed away from other medical conditions. Conclusions: Endoscopic calcium electroporation is a safe, palliative option effective for tumor reduction and symptomatic relief in frail CRC patients unfit for conventional therapies. Full article

Background and Objectives: Many middle-aged and older individuals experience shoulder pain, often due to partial-thickness rotator cuff tears (PTRCTs). If conservative treatment fails to relieve symptoms in a patient, surgical intervention may be necessary. In such cases, using a bioinductive collagen implant may offer a viable alternative to conventional rotator cuff repair. Most notably, it offers potential advantages, particularly in reducing postoperative pain and promoting faster recovery. Accordingly, this study aims to evaluate the clinical outcomes of treating bursal-sided partial-thickness rotator cuff tears using bioinductive collagen implants alone, without concurrent rotator cuff repair. Materials and Methods: We followed 32 patients who had bursal-sided partial-thickness rotator cuff tears (Ellman grade I or II) and received conservative care for more than six months but continued to experience symptoms. These patients received surgery using bioinductive collagen implants without rotator cuff repair, and we followed up on their postoperative prognosis for at least one year after surgery. For a more accurate contrast, we performed clinical evaluation preoperatively and at 2 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and Western Ontario Rotator Cuff (WORC) score were used as assessment tools in this study. As for radiological outcomes, magnetic resonance imaging (MRI) and ultrasonography were helpful. This supported our assessment of graft integration and failure. Results: These 32 patients included 13 with Ellman grade I tear and 19 with grade II tear. In both cases, they underwent surgery only using bioinductive collagen implants, and any anchor-based cuff repair was completely excluded. As for VAS (3.8 ± 2.9), certain statistically significant improvements were found starting at 2 weeks postoperatively. On the other hand, the scores of ASES (58.6 ± 20.3), SANE (60.1 ± 23.2), and WORC (59.8 ± 22.4) began to indicate a significant improvement starting at 6 weeks postoperatively (p < 0.001), showing continuous progress. At each final step, we confirmed that there were no cases of graft failure by radiological evaluation and found successful healing indicators, such as much less pain in all patients. Conclusions: The findings of this study provide the clinical evidence that a surgery using bioinductive collagen implant for bursal-sided partial-thickness rotator cuff tears is a highly effective treatment option in patients unresponsive to conservative therapy. Particularly, its practical clinical effectiveness includes facilitating rapid recovery without a significant risk of complications. Full article

Objective: The American Urological Association recommends ablation as an alternative treatment option for T1a RCC smaller than 3 cm. Our objective is to describe our technique and evaluate the outcomes of radiofrequency ablation (RFA) for biopsy-proven T1a RCC measuring 3–4 cm, compared to outcomes for tumors <3 cm. Materials and Methods: A single-center, retrospective review included patients with solitary, de novo, biopsy-proven T1a RCC who underwent RFA between January 2001 and December 2020. Using propensity score matching, patients with 3–4 cm lesions (Group A) were matched with patients with lesions less than 3 cm (Group B) based on the pathology, grade, duration of follow-up, another primary malignancy, age, and sex. Survival outcomes were estimated using the Kaplan and Meier product-limit estimator, and both groups were compared. Results: A total of 122 patients were included in the matched analyses. Eight patients were missing data on disease recurrence, leaving 114 patients with data on RFS and DFS (55 patients in Group A and 59 patients in Group B). The median tumor size in groups A and B was 3.3 cm and 2.2 cm, respectively. There was no statistically significant difference in the complication rate (p = 0.11) and local recurrence at the ablation site (p = 0.15). There was no statistically significant difference in overall survival (p = 0.93), recurrence-free survival (p = 0.45), or disease-free survival (p = 0.37). The metastasis-free survival and cancer-specific survival were 100% in both groups. Conclusions: RFA is a highly effective modality for the treatment of 3–4 cm T1a RCC, with long-term favorable oncologic and survival outcomes. Full article

Objectives: This study aims to evaluate the efficacy and safety of oral supplementation with hydrolyzed collagen peptides (HCP) type I and type III (CollaSel PRO^®) in reducing joint pain and stiffness and improving physical function in patients with osteoarthritis (OA). Methods: In this randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT05369780; approved by the Institutional Review Board), 160 adult patients with OA (mean age 52.4 ± 4.3 years; 111 females, 49 males) were randomly assigned to receive either 10 g/day of CollaSel PRO^® (n = 80) or placebo (maltodextrin, n = 80) for 8 weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to evaluate knee and hip joints, and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHFS) was used for ankle joints. Assessments were conducted at baseline and at weeks 1, 4, and 8. Results: In the CollaSel PRO^® group, a significant decrease in WOMAC scores (mean ± SD 50.5 ± 17.0, 40.7 ± 16.9 and 33.8 ± 16.5 vs. 53.7 ± 16.9, respectively, p < 0.001 for each) and significant increase in AOFAS-AHFS scores (64.2 ± 13.1, 73.6 ± 12.3 and 80.8 ± 9.9 vs. 61.8 ± 13.9, respectively, p < 0.001 for each) were noted at weeks 1, 4, and 8 compared to the baseline scores. WOMAC scores were significantly lower in comparing HCP and placebo, and AOFAS-AHFS scores were higher in the HCP group compared to the placebo group at weeks 4 and 8 (all p < 0.001). Conclusions: CollaSel PRO^® appears to be a safe and effective option for the symptomatic management of osteoarthritis. It significantly improved joint pain, stiffness, and physical function in multiple joints. These improvements are not only statistically significant but also clinically meaningful, supporting the need for longer-term evaluation. Full article