Cardiovascular MRI: its current and future use in clinical practice

Cardiovascular magnetic resonance (CMR) imaging is a comprehensive clinical tool for assessing a large variety of cardiovascular diseases. Using the clinical service of the Duke Cardiovascular Magnetic Resonance Center as an example, we describe how to perform image contractile function, myocardial perfusion at stress and rest, myocardial viability, cardiovascular morphology, vascular anatomy and blood flow tests. The emergence of successful dedicated CMR services presents an opportunity to optimize patient throughput by streamlining the user interface of CMR scanners, standardizing the viewing format and reporting software, and customizing training programs to focus on the standardized CMR approaches. Accordingly, we discuss potential pathways to create these standards. Finally, we discuss several promising new CMR techniques we expect will complement existing clinical procedures.     

Cardiovascular MRI: its current and future use in clinical practice

Cardiovascular magnetic resonance (CMR) imaging is a comprehensive clinical tool for assessing a large variety of cardiovascular diseases. Using the clinical service of the Duke Cardiovascular Magnetic Resonance Center as an example, we describe how to perform image contractile function, myocardial perfusion at stress and rest, myocardial viability, cardiovascular morphology, vascular anatomy and blood flow tests. The emergence of successful dedicated CMR services presents an opportunity to optimize patient throughput by streamlining the user interface of CMR scanners, standardizing the viewing format and reporting software, and customizing training programs to focus on the standardized CMR approaches. Accordingly, we discuss potential pathways to create these standards. Finally, we discuss several promising new CMR techniques we expect will complement existing clinical procedures.     

乳腺超声诊断的现况与展望

随着高频超声及彩色多普勒超声技术的迅速发展,超声图像的分辨率及对低速血流的敏感性不断提高,乳腺癌及乳腺良性病变的超声诊断、鉴别诊断成为影像学研究热点,乳腺超声临床应用的进一步普及,使超声对乳腺疾病的诊断进入了一个新阶段.     

Breast cancer chemoprevention: a review of selective estrogen receptor modulators

Breast cancer is the most common cancer diagnosis among women in the United States. Chemoprevention plays an important role for women at high risk for developing breast cancer. The use of selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene has demonstrated mixed results in breast cancer prevention clinical trials. In the United States, tamoxifen is approved for use for breast cancer prevention in women at high risk. The continued development of SERMs with improved side-effect profiles is needed. Oncology nurses play a pivotal role in helping patients to understand the current status of breast cancer prevention as well as the future direction of research.     

Risk factors and current chemoprevention studies in prostate cancer

There are no established risk factors for prostate cancer other than age, ethnic group, and family history. For dietary factors, the WCRF/AICR reported that diets high in vegetables were possibly protective, and that regular consumption of red meat, fat, saturated/animal fat, and milk and any products possibly increased risk. Among nutritional factors, a protective effect of lycopene, vitamin E, selenium, and perhaps fish oil and phytoestrogens appear particularly promising, although no definite answers have yet emerged. Although hormonal influences are biologically plausible, observational studies of androgen have not produced consistent results. While, insulin-like growth factor 1 could be a risk factor. Based on these evidences, several chemoprevention trials were launched using 5-alpha reductase inhibitor, selenium, vitamin E and so on.     

Emergency medicine in Nepal: present practice and direction for future

Emergency medicine is one of the youngest recognized specialties in Nepal, and its growth in clinical practice and academic development has been challenging. In this paper, we reviewed the current state of emergency medicine in Nepal based on review of the literature, personal observations and experience, and interviews with many Nepali and foreign emergency physicians. Most hospitals in Nepal have adopted a multi-specialist approach, where emergency room physicians are primarily general practitioners/family physicians or house officers. As physicians are receiving their training via various pathways, national standards in training and certification have not been developed. As a result, the scope of practice for emergency physicians and the quality of care vary greatly among hospitals. Difficult working conditions, physician recruitment, compensation, and academic enrichment remain major challenges in the development of emergency medicine. For the sustainable development of this specialty, more international guidance and local leadership is needed to standardize the training curriculum, to provide adequate funding opportunities for academic development and to promote the overall development of the emergency care system.     

Breast cancer research: affecting the future

Research plays a pivotal role in the oncology treatment continuum. As research moves from the academic arena into the community, the nurse practitioner is more likely to be faced with the challenge of enrolling and managing trial participants. This article addresses various issues related to breast cancer research and the management of trial participants.     

Intracranial aneurysms: current evidence and clinical practice

Unruptured intracranial aneurysms occur in up to 6 percent of the general population. Most persons with these aneurysms remain asymptomatic and are usually unaware of their presence. Risk factors for the formation of aneurysms include a family history of aneurysm, various inherited disorders, age greater than 50 years, female gender, current cigarette smoking, and cocaine use. Because of the morbidity and mortality associated with surgical intervention, screening for aneurysms remains controversial. Two groups of patients may benefit from early detection: those with autosomal dominant polycystic kidney disease and those with a history of aneurysmal subarachnoid hemorrhage. These patients should undergo magnetic resonance angiography, followed by neurosurgical referral if an aneurysm is detected. Screening of patients who have two or more family members with intracranial aneurysms is controversial. Screening of patients who have one first-degree relative with an aneurysm does not appear to be beneficial.     

Deep brain stimulation: current and future clinical applications

Deep brain stimulation (DBS) has developed during the past 20 years as a remarkable treatment option for several different disorders. Advances in technology and surgical techniques have essentially replaced ablative procedures for most of these conditions. Stimulation of the ventralis intermedius nucleus of the thalamus has clearly been shown to markedly improve tremor control in patients with essential tremor and tremor related to Parkinson disease. Symptoms of bradykinesia, tremor, gait disturbance, and rigidity can be significantly improved in patients with Parkinson disease. Because of these improvements, a decrease in medication can be instrumental in reducing the disabling features of dyskinesias in such patients. Primary dystonia has been shown to respond well to DBS of the globus pallidus internus. The success of these procedures has led to application of these techniques to multiple other debilitating conditions such as neuropsychiatric disorders, intractable pain, epilepsy, camptocormia, headache, restless legs syndrome, and Alzheimer disease. The literature analysis was performed using a MEDLINE search from 1980 through 2010 with the term deep brain stimulation, and several double-blind and larger case series were chosen for inclusion in this review. The exact mechanism of DBS is not fully understood. This review summarizes many of the current and potential future clinical applications of this technology.     

Breast cancer: initial diagnosis and current treatment options

Topics discussed in this article are breast cancer versus benign breast conditions, the importance of physical examination used in conjunction with screening mammography in the detection of abnormalities, imaging options, diagnosis, treatment options, and the importance of follow-up care.     

Liquid biopsy in the clinical management of bladder cancer: current status and future developments

ABSTRACT

Introduction: The use of liquid biopsy on the blood from solid malignancies provides a convenient way of detecting actionable mutations, monitoring treatment response, detecting early recurrence and prognosticating outcomes. The aim of this review is to discuss the current status and future direction of serum biomarkers in the clinical management of urinary bladder cancer.

Areas covered: This review provides an overview of blood liquid biopsy and bladder cancer using methods of circulating tumors cells, circulating RNA, serum metabolites and cell-free DNA. Recent clinical studies and advances in methodology are emphasized. We performed a literature search using PMC/PubMed with keywords including ‘liquid biopsy’, ‘circulating tumor DNA’, ‘cell-free DNA’, ‘biomarkers’, ‘bladder cancer’ ‘precision medicine’. Additional articles were obtained from the cited references of key articles. An emphasis was placed on recent studies published since 2018.

Expert opinion: Liquid biopsies represent a potential biomarker using cell-free DNA, metabolomic profiles of altered cellular metabolism, circulating cancer cells and RNA. Despite displaying tremendous clinical promise, the current status of the blood liquid biopsies has not reached fruition. However, future investigations should lead the evolution of liquid biomarker into clinical utility for the management of bladder cancer.     

Breast cancer proteomics: clinical perspectives

Breast cancer is the one of leading causes of cancer-related deaths in women within economically developed regions of the world. A major focus of present research into this malignancy is the identification of new biomarkers and drug targets to improve detection and treatment. Proteomics represents one of the latest technological developments in this context. It aims to analyse the complex circuitry of the breast cancer proteome. Here, the authors review how breast cancer proteomics has progressed so far, with emphasis on its potential application to clinically relevant scenarios.     

Gefitinib: current and future status in cancer therapy

The epidermal growth factor receptor (EGFR) is recognized as a key modulator of tumor cell function and is considered to be a viable drug target in a range of solid malignancies. Current knowledge of its role in tumor growth and progression has led to a newly active area of anticancer research, investigating agents that target the activity of this receptor. Of these agents, gefitinib is furthest in clinical development, having received regulatory approval in Japan in 2002, and in the United States and Australia in 2003. Gefitinib is an orally active, EGFR-tyrosine kinase inhibitor that blocks signal transduction pathways implicated in the proliferation and survival of cancer cells and other host-dependent processes promoting cancer cell growth. A plethora of preclinical studies have suggested promising outcomes for this agent and have led to ongoing clinical trials in a wide range of tumors, including non-small-cell lung, head and neck, colorectal, prostate, and breast, either as monotherapy or in combination with standard chemotherapy, hormonal therapy, or radiotherapy. Furthermore, as biologic agents are specifically designed to attack different pathways of tumor growth and progression, the potential for the combination of gefitinib with other agents, given either concurrently or sequentially, to prevent or delay disease recurrence is also being investigated. This article provides a detailed overview of gefitinib, the rationale for its use in a wide range of tumor types, and the current clinical development status of this novel agent.