Publications by authors named "Nicholas Syn"
Article Synopsis
- Recent studies indicate that machine learning (ML) algorithms may be useful for predicting patient outcomes after percutaneous coronary intervention (PCI).
- The review analyzed 11 studies involving nearly 5 million patients and found that while ML models demonstrated high diagnostic accuracy, issues like poor handling of missing data and lack of external validation raise concerns about their reliability.
- Although ML models show potential as supplemental tools for traditional risk assessments, there are significant hurdles that must be overcome before they can be effectively used in clinical settings.
Article Synopsis
- The study investigates the unclear incidence of cognitive impairment or dementia in patients after coronary artery bypass grafting (CABG) and identifies associated risk factors.* -
- A systematic search of 23 studies involving 2,620 patients revealed that the incidence of cognitive issues was notably high, especially within the first month and after one year post-surgery, with rates of 35.96% and 39.13%, respectively.* -
- Hypertension was found to be a significant risk factor for cognitive impairment shortly after CABG, highlighting the need for further research to develop strategies to mitigate these cognitive issues post-surgery.*
Article Synopsis
- Current guidelines for managing asymptomatic severe aortic stenosis (AS) patients are unclear due to insufficient data on their natural history.
- A systematic review and meta-analysis of 46 studies with 9,545 patients indicated that almost half experienced significant cardiovascular events within 5 years, with many developing symptoms or requiring surgery.
- The findings highlight the need for better understanding and management strategies for these patients, given their poor long-term cardiovascular outcomes.
Background: Although the burden of alcohol-associated hepatocellular carcinoma (HCC) is increasing with rising alcohol consumption, clinical presentation and outcomes of alcohol-associated HCC have not been systematically assessed. We aimed to determine the prevalence, clinical characteristics, surveillance rates, treatment allocation, and outcomes of alcohol-associated HCC.
Methods: Medline and Embase were searched from inception to January 2023.
Background: To overcome the limitations of the term "non-alcoholic fatty liver disease" (NAFLD), the term metabolic-associated steatotic liver disease (MASLD) was introduced. While epidemiologic studies have been conducted on MASLD, there is limited evidence on its associated sex and ethnic variations.
Aims: This study assesses the differences across sex and race-ethnicity on the prevalence, associated risk factors and adverse outcomes in individuals with MASLD.
Background: Metformin and sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits but their comparative effects on mortality in type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD) are unknown. Hence, we evaluated and compared lifetime benefits arising from metformin or SGLT2 inhibitors in T2DM patients with CVD.
Materials And Methods: Studies published in the PubMed, EMBASE and CENTRAL databases before 28 October 2023 were retrieved.
Article Synopsis
- KRAS mutation negatively impacts survival outcomes for patients with colorectal liver metastases, with those having mutated KRAS showing significantly shorter overall and disease-free survival compared to those with wild-type KRAS.
- The study analyzed data from 593 patients to compare the effects of R0 (no cancer at margins) and R1 (cancer at margins) resections based on KRAS status, finding that R0 resections benefit wild-type patients but not those with KRAS mutations.
- In KRAS wild-type tumors, R0 resections were linked to longer survival, while in KRAS-mutated tumors, the resection margin did not influence outcomes, emphasizing the aggressive nature of KRAS-mutated cancers.
Macrophages are abundant immune cells in the microenvironment of diffuse large B-cell lymphoma (DLBCL). Macrophage estimation by immunohistochemistry shows varying prognostic significance across studies in DLBCL, and does not provide a comprehensive analysis of macrophage subtypes. Here, using digital spatial profiling with whole transcriptome analysis of CD68+ cells, we characterize macrophages in distinct spatial niches of reactive lymphoid tissues (RLTs) and DLBCL.
View Article and Find Full Text PDFBackground: Patients with migraines, particularly those with auras, may present with stroke. Atrial fibrillation is a known risk factor for stroke. With common pathophysiological factors between migraines and atrial fibrillation, we aimed to clarify the association between migraine and atrial fibrillation in this systematic review and meta-analysis.
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- - The 2023 Congress of ILTS, ELITA, and LICAGE in Rotterdam was a pivotal event for the liver transplant community, marking a recovery after COVID-19 with 1159 participants and increased abstract submissions.
- - The conference centered around "Liver Disorders and Transplantation: Innovations and Evolving Indications," covering various topics in Hepatology, Surgical Approaches, and more.
- - It served as a vital platform for discussions on advancements and collaborative efforts in the liver transplant field, highlighting ongoing innovations and evolving practices.
Article Synopsis
- ChatGPT, an AI chatbot from OpenAI, was assessed for its effectiveness in diagnostic histopathology compared to human pathologists in a study that examined its collaborative potential.* -
- The study revealed that ChatGPT's diagnostic accuracy was inferior to that of pathologists, and while its responses depended on the quality of prompts, it provided limited assistance in diagnosing cases.* -
- Despite its shortcomings, pathologists acknowledged ChatGPT's utility as an advanced search tool, suggesting that future improvements in AI could enhance its role in histopathology.*
The scarcity of liver grafts has prompted developments in living donor liver transplantations (LDLT), with previous literature illustrating similar outcomes in recipients compared to deceased donor transplants. However, significant concerns regarding living donor morbidity and mortality have yet to be examined comprehensively. This study aims to provide estimates of the incidence of various outcomes in living liver donors.
View Article and Find Full Text PDFBackground: Currently, the outcomes of standard-of-care palliative treatment for BCLM remain poor. Recent literature has shown promising results of hepatic resection, however, not all studies concur. Given the lack of standardized international guidelines in this field, the aim of this study is to provide gold-standard evidence for breast cancer liver metastases (BCLM) through a reconstructed individual patient data meta-analysis approach.
View Article and Find Full Text PDFBackground: Emerging data suggest that outcomes for advanced hepatocellular carcinoma (HCC) treated with sorafenib may have improved over time. We aimed to provide robust, time-to-event estimates of survival outcomes for sorafenib in advanced HCC.
Summary: In this systematic review and individual patient data meta-analysis of randomized-controlled trials (RCTs), we searched MEDLINE and Embase from inception till September 2022 for RCTs that provided data for overall survival (OS) and progression-free survival (PFS) for sorafenib monotherapy as first-line systemic therapy for advanced HCC.
Background: Preliver transplant diabetes mellitus (pre-LT DM) is a common comorbidity in LT recipients associated with poorer post-transplant survival. However, its relationship with other important outcomes, including cardiovascular and renal outcomes, remains unclear. This meta-analysis aims to provide an updated analysis of the impact of pre-LT DM on key post-LT outcomes.
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- Bariatric surgery is a key treatment for severely obese patients with nonalcoholic fatty liver disease (NAFLD), but there is limited data on how different surgical procedures impact histological outcomes related to NAFLD.
- A meta-analysis of 31 studies found that both foregut bypass and restrictive bariatric procedures significantly improved liver fibrosis, but foregut bypass showed better results for reducing liver fat and body mass index.
- Foregut bypass also led to lower levels of certain liver enzymes compared to restrictive procedures, suggesting it may be the more effective option for improving metabolic and histological parameters in NAFLD patients.
Article Synopsis
- The study investigates the long-term risks associated with metabolic dysfunction-associated steatotic liver disease (MASLD) by analyzing data from 129 original studies comparing MASLD patients to those without the condition.* -
- Results indicate that individuals with MASLD have a higher risk of various complications, including cardiovascular issues, metabolic disorders (like diabetes and hypertension), chronic kidney disease, and certain cancers, with those having advanced liver disease at an even greater risk.* -
- The findings highlight the need for comprehensive treatment approaches for MASLD due to its serious multisystem effects on health.*
Post Living Donor Liver Transplantation Small-for-size Syndrome: Definitions, Timelines, Biochemical, and Clinical Factors for Diagnosis: Guidelines From the ILTS-iLDLT-LTSI Consensus Conference.
Transplantation
October 2023
Article Synopsis
- * A Consensus Scientific committee, comprised of 106 members from 21 countries, conducted an in-depth literature review and reached recommendations regarding ideal graft-to-recipient weight ratios, monitoring portal pressure and flow, and diagnosing SFSS around postoperative day 7.
- * The committee proposed a new 3-grade severity stratification system to help clinicians identify patients at risk for SFSS early on, suggesting that further studies are necessary to validate this system.
Background: Some observational studies and randomised controlled trials (RCTs) have reported an association between calcium supplementation and increased risk of cardiovascular disease. Previous meta-analyses on the topic, based on data from RCTs and observational studies, have contradictory findings. This meta-analysis was conducted to determine the difference in associated risks of calcium supplementation with cardiovascular disease and stroke in RCTs.
View Article and Find Full Text PDFBackground: Bilobar liver metastases from colorectal cancer pose a challenge for obtaining a satisfactory oncological outcome with an adequate future liver remnant. This study aimed to assess the clinical and pathological determinants of overall survival and recurrence-free survival among patients undergoing surgical clearance of bilobar liver metastases from colorectal cancer.
Methods: A retrospective international multicentre study of patients who underwent surgery for bilobar liver metastases from colorectal cancer between January 2012 and December 2018 was conducted.
Background: Non-alcoholic fatty liver disease (NAFLD) represents a significant health threat worldwide. The growing trend towards an aging population, along with an alarming rise in obesity and diabetes, may have significant implications for the burden of NAFLD.
Aim: To assess the impact of NAFLD on the elderly.
Background: The conventional approach to treatment for Paget's disease of the breast has been mastectomy, but there is an increasing trend to consider breast-conserving surgery (BCS) followed by radiotherapy (RT) in these patients. This study aimed to provide an updated systematic review and meta-analysis comparing outcomes after BCS with RT versus mastectomy in the treatment of Paget's disease of the breast.
Methods: Studies before May 2021 were included.
Importance: Emerging data suggest that the incidence of early-onset cancers, defined as cancers diagnosed in people younger than 50 years, is increasing, but updated data are limited.
Objective: To characterize the patterns in the incidence of early-onset cancers in the US from 2010 to 2019 and provide granular data on the cancers with the fastest-growing incidence rates.
Design, Setting, And Participants: This population-based cohort study analyzed data from 17 National Cancer Institute Surveillance, Epidemiology, and End Results registries from January 1, 2010, to December 31, 2019.
Article Synopsis
- Tumor size (TS) impacts intraoperative outcomes in laparoscopic major hepatectomy (L-MH), with this study aiming to clarify its effects and find optimal TS cutoffs for assessing surgical difficulty.
- The analysis, which included 1396 patients from a larger pool of 3008 undergoing L-MH, identified two critical TS cutoffs at 50 mm and 100 mm that segmented patients into three distinct groups.
- Results showed that larger TS correlated with increased open conversion rates, longer operation times, higher blood loss, and more intraoperative blood transfusions, while postoperative complications remained similar across the groups.
Introduction: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease, with type 2 diabetes mellitus (T2DM) as a major predictor. Insulin resistance and chronic inflammation are key pathways in the pathogenesis of T2DM leading to NAFLD and vice versa, with the synergistic effect of NAFLD and T2DM increasing morbidity and mortality risks. This meta-analysis aims to quantify the prevalence of NAFLD and the prevalence of clinically significant and advanced fibrosis in people with T2DM.
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