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Guideline Open Access
Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus (Version 2024)
Jinfeng Liu, Qinglei Zeng, Fanpu Ji, Hong Ren, Wenhong Zhang, Lanjuan Li, Yingren Zhao, Infectious Diseases Physicians Branch, Chinese Medical Doctor Association and Chinese Society of Infectious Diseases, Chinese Medical Association
Published online October 29, 2024
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2024.00258
Abstract
The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus, developed by the Chinese Society of Infectious Diseases [...] Read more.

The Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-child Transmission of Hepatitis B Virus, developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019, serves as a valuable reference for standardizing the prevention of mother-to-child transmission in China. As new evidence continues to emerge, it is essential to update these guidelines regularly to optimize clinical practice and research. To this end, the Infectious Disease Physician Branch of the Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of the Chinese Medical Association, in collaboration with multidisciplinary experts, have updated the guidelines based on the latest domestic and international research advancements and clinical practices, providing up-to-date guidance for clinicians and maternal and child healthcare workers.

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Review Article Open Access
Machine Learning Approach towards Quality Assurance, Challenges and Possible Strategies in Laboratory Medicine
Qurrat Ul Ain, Rameesha Nazir, Aleeza Nawaz, Hamza Shahbaz, Areeba Dilshad, Isra Umbreen Mufti, Mariam Iftikhar
Published online June 20, 2024
Journal of Clinical and Translational Pathology. doi:10.14218/JCTP.2023.00061
Abstract
The burgeoning integration of machine learning (ML) and automation in laboratory medicine marks a significant shift, propelling the sector towards enhanced diagnostic accuracy and [...] Read more.

The burgeoning integration of machine learning (ML) and automation in laboratory medicine marks a significant shift, propelling the sector towards enhanced diagnostic accuracy and operational efficiency. This critical analysis investigates the technological paces being made to enhance the analytical precision and the efficient interpretation of complicated clinical/laboratory-based datasets. The beginning of automation, coupled with ML, ushers in an era where algorithmic expertise and predictive analytics supplement significantly elevating established diagnostic methods, thereby setting higher standards for reliability and quality in clinical laboratory testing. However, this technological advancement is not without its challenges. This review highlights several concerns about data privacy, the need for rigorous validation procedures, the difficulty of integrating new technology into primitive systems, and the continuous struggle to comply with guidelines. Financial constraints exacerbate these issues, particularly in settings with limited resources in developing and underdeveloped countries. To address these challenges, the review presents several strategic methods, including the development of international guidelines for algorithmic validation, interdisciplinary collaborations to match technology developments to healthcare demands, workforce training campaigns, and the implementation of ethical guidelines for the usage of ML approaches in lab environments. The review provides a concise yet comprehensive analysis of the current situation, highlighting challenges and possible solutions associated with automation and ML in laboratory medicine. It establishes the foundation for a future anticipated to have advanced diagnostics that are also more tailored to personalized patient care.

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Original Article Open Access
Real-world Effectiveness and Tolerability of Interferon-free Direct-acting Antiviral for 15,849 Patients with Chronic Hepatitis C: A Multinational Cohort Study
Fanpu Ji, Sally Tran, Eiichi Ogawa, Chung-Feng Huang, Takanori Suzuki, Yu Jun Wong, Hidenori Toyoda, Dae Won Jun, Liu Li, Haruki Uojima, Akito Nozaki, Makoto Chuma, Cheng-Hao Tseng, Yao-Chun Hsu, Masatoshi Ishigami, Takashi Honda, Masanori Atsukawa, Hiroaki Haga, Masaru Enomoto, Huy Trinh, Carmen Monica Preda, Phillip Vutien, Charles Landis, Dong Hyun Lee, Tsunamasa Watanabe, Hirokazu Takahashi, Hiroshi Abe, Akira Asai, Yuichiro Eguchi, Jie Li, Xiaozhong Wang, Jia Li, Junping Liu, Jing Liang, Carla Pui-Mei Lam, Rui Huang, Qing Ye, Hongying Pan, Jiajie Zhang, Dachuan Cai, Qi Wang, Daniel Q. Huang, Grace Wong, Vincent Wai-Sun Wong, Junyi Li, Son Do, Norihiro Furusyo, Makoto Nakamuta, Hideyuki Nomura, Eiji Kajiwara, Eileen L. Yoon, Sang Bong Ahn, Koichi Azuma, Kazufumi Dohmen, Jihyun An, Do Seon Song, Hyun Chin Cho, Akira Kawano, Toshimasa Koyanagi, Aritsune Ooho, Takeaki Satoh, Kazuhiro Takahashi, Ming-Lun Yeh, Pei-Chien Tsai, Satoshi Yasuda, Yunyu Zhao, Yishan Liu, Tomomi Okubo, Norio Itokawa, Mi Jung Jun, Toru Ishikawa, Koichi Takaguchi, Tomonori Senoh, Mingyuan Zhang, Changqing Zhao, Raluca Ioana Alecu, Wei Xuan Tay, Pooja Devan, Joanne Kimiko Liu, Ritsuzo Kozuka, Elena Vargas-Accarino, Ai-Thien Do, Mayumi Maeda, Wan-Long Chuang, Jee-Fu Huang, Chia-Yen Dai, Ramsey Cheung, Maria Buti, Junqi Niu, Wen Xie, Hong Ren, Seng Gee Lim, Chao Wu, Man-Fung Yuen, Jia Shang, Qiang Zhu, Yoshiyuki Ueno, Yasuhito Tanaka, Jun Hayashi, Ming-Lung Yu, Mindie H. Nguyen
Published online June 17, 2024
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2024.00089
Abstract
As practice patterns and hepatitis C virus (HCV) genotypes (GT) vary geographically, a global real-world study from both East and West covering all GTs can help inform practice [...] Read more.

As practice patterns and hepatitis C virus (HCV) genotypes (GT) vary geographically, a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal. This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs, focusing on GT3 and GT6.

We analyzed the sustained virological response (SVR12) of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific, North America, and Europe between 07/01/2014–07/01/2021.

The mean age was 62±13 years, with 49.6% male. The demographic breakdown was 91.1% Asian (52.9% Japanese, 25.7% Chinese/Taiwanese, 5.4% Korean, 3.3% Malaysian, and 2.9% Vietnamese), 6.4% White, 1.3% Hispanic/Latino, and 1% Black/African-American. Additionally, 34.8% had cirrhosis, 8.6% had hepatocellular carcinoma (HCC), and 24.9% were treatment-experienced (20.7% with interferon, 4.3% with direct-acting antivirals). The largest group was GT1 (10,246 [64.6%]), followed by GT2 (3,686 [23.2%]), GT3 (1,151 [7.2%]), GT6 (457 [2.8%]), GT4 (47 [0.3%]), GT5 (1 [0.006%]), and untyped GTs (261 [1.6%]). The overall SVR12 was 96.9%, with rates over 95% for GT1/2/3/6 but 91.5% for GT4. SVR12 for GT3 was 95.1% overall, 98.2% for GT3a, and 94.0% for GT3b. SVR12 was 98.3% overall for GT6, lower for patients with cirrhosis and treatment-experienced (TE) (93.8%) but ≥97.5% for treatment-naive patients regardless of cirrhosis status. On multivariable analysis, advanced age, prior treatment failure, cirrhosis, active HCC, and GT3/4 were independent predictors of lower SVR12, while being Asian was a significant predictor of achieving SVR12.

In this diverse multinational real-world cohort of patients with various GTs, the overall cure rate was 96.9%, despite large numbers of patients with cirrhosis, HCC, TE, and GT3/6. SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent (>91%).

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Review Article Open Access
Histopathologic Features and Differential Diagnosis in Challenging Cases of Nodular Lymphocyte Predominant B-cell Lymphoma/Nodular Lymphocyte Predominant Hodgkin Lymphoma
Yanna Ding, Elaine S. Jaffe
Published online June 17, 2024
Journal of Clinical and Translational Pathology. doi:10.14218/JCTP.2024.00015
Abstract
Nodular lymphocyte predominant Hodgkin lymphoma was termed “nodular lymphocyte predominant B-cell lymphoma” in the International Consensus Classification (ICC), to emphasize clinical [...] Read more.

Nodular lymphocyte predominant Hodgkin lymphoma was termed “nodular lymphocyte predominant B-cell lymphoma” in the International Consensus Classification (ICC), to emphasize clinical and biological differences from classic Hodgkin lymphoma (CHL). The abbreviation “NLP” represents both terms in the ICC and World Health Organization classifications. Variations in the growth pattern, originally reported as Fan patterns A-F, are designated as either grade 1 or grade 2 in the ICC. NLP is uncommon, and in some cases an accurate diagnosis is challenging. The objectives of this article were to review the histopathologic features of NLP and the differential diagnosis from other key entities including de novo T-cell/histiocyte-rich large B-cell lymphoma (THRLBL) and lymphocyte-rich classic Hodgkin lymphoma (LRCHL). Histologically, NLP Fan pattern E (THRLBL-like) can be indistinguishable from de novo THRLBL. However, focal nodular areas, clustering of tumor cells, presence of few admixed small B-cells or FDC meshworks, and T-cell rosettes favor NLP Fan pattern E and argue against de novo THRLBL. NLP may also be confused with LRCHL. Patients with NLP are younger than those with LRCHL, and LRCHL may show mediastinal involvement. In LRCHL, the nodular pattern often contains eccentrically located small regressed germinal centers and intact small dense FDC meshworks, in contrast to the expanded, and fragmented FDC meshworks in NLP. Neoplastic cells that are positive for CD30 and CD15 but negative for CD20 and CD79a are characteristic of LRCHL. Additionally, Fascin and Gata3 are commonly positive in LRCHL but usually negative in NLP.

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Review Article Open Access
Advances in the Treatment of Autoimmune Hepatitis
Zelu Meng, Yida Yang
Published online September 24, 2024
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2024.00193
Abstract
Autoimmune hepatitis (AIH) is a chronic, progressive inflammatory liver disease caused by autoimmune reactions, with an unknown etiology. If left untreated, it can progress to cirrhosis, [...] Read more.

Autoimmune hepatitis (AIH) is a chronic, progressive inflammatory liver disease caused by autoimmune reactions, with an unknown etiology. If left untreated, it can progress to cirrhosis, liver failure, or even death. While most patients respond well to first-line treatments, a significant number experience poor responses or intolerance, requiring the use of second- or third-line therapies. Ongoing research into the pathogenesis of AIH is leading to the development of novel therapeutic approaches. This review summarized recent advancements in the treatment of AIH both domestically and internationally.

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Review Article Open Access
Oral Cancer Screening: Insights into Epidemiology, Risk Factors, and Screening Programs for Improved Early Detection
Amit Kumar Jain
Published online June 18, 2024
Cancer Screening and Prevention. doi:10.14218/CSP.2023.00029S
Abstract
Early detection of oral cancer is crucial for improving prognosis, increasing survival rates, and reducing treatment-related morbidity, considering the high mortality rate associated [...] Read more.

Early detection of oral cancer is crucial for improving prognosis, increasing survival rates, and reducing treatment-related morbidity, considering the high mortality rate associated with this condition. However, the conventional approach within communities has led to a growing exploration of different screening methods to detect potentially malignant oral disorders, with particular emphasis on imaging and artificial intelligence and their integration with conventional approaches. The article reviewed literature on oral neoplasms and early cancer detection from databases like Medline, Google Scholar, and Web of Science, mainly from 2001 to 2023. This review aims to shed light on the potential of these technologies, new ideas, and methods in improving the accuracy and effectiveness of oral cancer screening, ultimately leading to earlier detection and more successful prevention strategies, which are unmet needs, especially in underdeveloped and developing nations.

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Review Article Open Access
Pediatric Functional Gastrointestinal Disorders: Pathophysiology, Diagnosis and Management
Aakash Mahesan, Gautam Kamila, Sheffali Gulati
Published online June 28, 2024
Journal of Translational Gastroenterology. doi:10.14218/JTG.2023.00075
Abstract
Functional Gastrointestinal Disorders (FGIDs), also recently referred to as disorders of gut-brain interaction, are common in the pediatric population and vary according to age [...] Read more.

Functional Gastrointestinal Disorders (FGIDs), also recently referred to as disorders of gut-brain interaction, are common in the pediatric population and vary according to age groups, i.e., neonatal/toddler and child/adolescent FGIDs. Pediatric FGIDs tend to evolve and persist into adulthood, contributing to financial burdens and psychological problems. Despite several decades of progress and advancements in molecular biology and medical sciences, the exact pathophysiology remains unknown, although genetic, psychosocial, gut dysbiosis, visceral hypersensitivity, and neuroimmune causes have been implicated. The ROME IV criteria facilitate easier and earlier diagnosis of FGIDs, excluding organic causes while minimizing unnecessary investigations. Dietary, psychosocial, neuro-stimulatory, and pharmacological management methods exist, although fewer trials have focused on pediatric drug-based management. Early identification and appropriate treatment hold the potential for cure and improvement in quality of life.

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Review Article Open Access
Bacterial Infections in Acute-on-chronic Liver Failure: Epidemiology, Diagnosis, Pathogenesis, and Management
Zhaoyu Xu, Xiuding Zhang, Jiyang Chen, Yu Shi, Shangwei Ji
Published online June 20, 2024
Journal of Clinical and Translational Hepatology. doi:10.14218/JCTH.2024.00137
Abstract
Acute-on-chronic liver failure (ACLF) is a distinct condition characterized by the abrupt exacerbation of pre-existing chronic liver disease, often leading to multi-organ failures [...] Read more.

Acute-on-chronic liver failure (ACLF) is a distinct condition characterized by the abrupt exacerbation of pre-existing chronic liver disease, often leading to multi-organ failures and significant short-term mortalities. Bacterial infection is one of the most frequent triggers for ACLF and a common complication following its onset. The impact of bacterial infections on the clinical course and outcome of ACLF underscores their critical role in the pathogenesis of systemic inflammation and organ failures. In addition, the evolving epidemiology and increasing prevalence of multidrug-resistant bacteria in cirrhosis and ACLF highlight the importance of appropriate empirical antibiotic use, as well as accurate and prompt microbiological diagnosis. This review provided an update on recent advances in the epidemiology, diagnosis, pathogenesis, and management of bacterial infections in ACLF.

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Review Article Open Access
Herbal-based Nutraceuticals in Management of Lifestyle Diseases: Experience from Indian Population
Anuradha Singh
Published online June 20, 2024
Future Integrative Medicine. doi:10.14218/FIM.2023.00055
Abstract
This review aims to highlight the growing burden of lifestyle diseases in India and explore the potential of herbal-based nutraceuticals as complementary or alternative management [...] Read more.

This review aims to highlight the growing burden of lifestyle diseases in India and explore the potential of herbal-based nutraceuticals as complementary or alternative management approaches. It emphasizes the need for a holistic approach to managing these diseases, acknowledging the potential of traditional remedies alongside modern medicine. Specifically, the article addresses several key points. It describes the rising prevalence of lifestyle diseases in India, providing a clear understanding of the current health landscape. Additionally, it introduces the concept of herbal-based nutraceuticals and their potential benefits in managing these diseases, offering alternative solutions. The article provides evidence-based information on popular herbal remedies such as turmeric, Ashwagandha, Indian gooseberry, Aloe vera, Neem, flaxseed, cinnamon, and green tea, offering specific examples and potential benefits. It highlights the growing awareness and increasing consumption of herbal-based nutraceuticals in India, reflecting a shift in public perception towards natural remedies. Finally, the article calls for further research to validate the efficacy and safety of these products in managing lifestyle diseases, ensuring responsible use, and promoting scientific validation.

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Original Article Open Access
Placental Malaria and Its Relationship with Neonatal Birth Weight among Primigravidae: An Analytical Cross-sectional Study
Kingsley R. Oranuka, Calvin Chama, Ibrahim O. Adogu, Chigozie G. Okafor, George U. Eleje, Emmanuel O. Ugwu, Olumide P. Adeleke, Palmer H. Obakpororo, Kenneth O. Nnabuchi, Abdulazeez Yusuf, Nnaemeka P. Ugwu, Josephat C. Akabuike, Ahizechukwu C. Eke
Published online June 20, 2024
Exploratory Research and Hypothesis in Medicine. doi:10.14218/ERHM.2023.00015
Abstract
Malaria can be fatal during pregnancy, posing a serious risk to both mothers and fetuses, especially in sub-Saharan Africa. Primigravidae are particularly susceptible to placental [...] Read more.

Malaria can be fatal during pregnancy, posing a serious risk to both mothers and fetuses, especially in sub-Saharan Africa. Primigravidae are particularly susceptible to placental malaria in areas with high rates of transmission due to insufficient immunity. This study aimed to determine the prevalence of placental malaria infection, risk factors, types of Plasmodium causing malaria during pregnancy, and its relationship with neonatal birth weight among primigravidae.

This was an analytical cross-sectional study involving 357 primigravidae who delivered at Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria. Placental blocks were taken from the pericentric area of the maternal surface of the placenta, and the birth weights of the neonates were recorded. The samples were fixed in 10% neutral-buffered formalin, and histopathological analysis was performed. The primary outcome measure was to determine the relationship between placental malaria and neonatal birth weight. Demographics and outcomes were analyzed using standard statistical tests. Multivariable regression models accounting for potential confounders were created for the primary and secondary outcomes with adjusted odds ratios as the measures of effect.

The prevalence of placental malaria was 38.4%. Among the participants with positive placenta malaria parasitemia, 49.6%, 36.5%, and 13.9% had chronic, acute, and past placental malaria infections, respectively. Only Plasmodium falciparum was found in the placenta. According to the bivariate analysis, unbooked status (p = 0.001), non-use of intermittent preventive therapy for malaria (p < 0.001), and village dwelling (p = 0.020) were significantly associated with placental malaria. However, on multivariable logistic regression, only non-uptake of intermittent preventive therapy for malaria was independently associated with placental malaria (adjusted odds ratio, 2.2, 95% confidence interval: 1.20, 4.1, p = 0.011). There was a significant difference in the mean birth weight between those with placental malaria and those without placental malaria (2.8 ± 0.5 kg vs. 3.2 ± 0.4 kg, p = 0.001). Additionally, placental malaria was significantly associated with low birth weight among the primigravidae (p < 0.001).

In Nigeria, there is a strong correlation between low birth weight and placental malaria in Primidravidae. Placental malaria was found to be independently correlated with non-uptake of intermittent preventive therapy for malaria.

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