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Topic Review
Intravesical Contrast-Enhanced MRI
While the poor resolution of soft tissue obtained by widely available imaging options such as abdominal sonography and radiation-based CT leaves them only suitable for measuring the gross tumor volume and bladder wall thickening, dynamic contrast-enhanced magnetic resolution imaging (DCE MRI) is demonstrably superior in resolving muscle invasion. However, major barriers still exist in its adoption. Instead of injection for DCE-MRI, intravesical contrast-enhanced MRI (ICE-MRI) instills Gadolinium chelate (Gadobutrol) together with trace amounts of superparamagnetic agents for measurement of tumor volume, depth, and aggressiveness. ICE-MRI leverages leaky tight junctions to accelerate passive paracellular diffusion of Gadobutrol (604.71 Daltons) by treading the paracellular ingress pathway of fluorescein sodium and of mitomycin (<400 Daltons) into bladder tumor. The soaring cost of diagnosis and care of bladder cancer could be mitigated by reducing the use of expensive operating room resources with a potential non-surgical imaging option for cancer surveillance, thereby reducing over-diagnosis and over-treatment and increasing organ preservation.
  • 363
  • 08 Jun 2023
Topic Review
Benefits of Prehabilitation before Complex Aortic Surgery
The term “complex aortic disease” encompasses juxta/pararenal aortic and thoraco-abdominal aneurysms, chronic aortic dissection and occlusive aorto-iliac pathology. Although endovascular surgery has been increasingly favored, open aortic surgery (OAS) remains a durable option, but by necessity involves extensive surgical approaches and aortic cross-clamping and requires a trained multidisciplinary team. The physiological stress of OAS in a fragile and comorbid patient group mandates thoughtful preoperative risk assessment and the implementation of measures dedicated to improving outcomes. Cardiac and pulmonary complications are one of the most frequent adverse events following major OAS and their incidences are correlated to the patient’s functional status and previous comorbidities. Prehabilitation should be considered in patients with risk factors for pulmonary complications including advanced age, previous chronic obstructive pulmonary disease, and congestive heart failure with the aid of pulmonary function tests. It should also be combined with other measures to improve postoperative course and be included in the more general concept of enhanced recovery after surgery (ERAS).
  • 225
  • 08 Jun 2023
Topic Review
Dysuricemia
The importance of uric acid, the final metabolite of purines excreted by the kidneys and intestines, was not previously recognized, except for its role in forming crystals in the joints and causing gout. Uric acid is not a biologically inactive substance and may exert a wide range of effects, including antioxidant, neurostimulatory, proinflammatory, and innate immune activities. 
  • 440
  • 08 Jun 2023
Topic Review
Role of Tamoxifen in Breast Cancer Management
Breast cancer (BC) is the most common female cancer in terms of incidence and mortality worldwide. Tamoxifen (Nolvadex) is a widely prescribed, oral anti-estrogen drug for the hormonal treatment of estrogen-receptor-positive BC, which represents 70% of all BC subtypes. 
  • 325
  • 08 Jun 2023
Topic Review
Overcoming Challenges in the Clinical Translation of MSC-Exosomes
MSC-based therapy for ophthalmic diseases has limitations in biocompatibility, penetration, and delivery. To address these challenges, researchers are exploring MSC exosomes, which possess similar properties to MSCs and efficiently deliver therapeutic factors to difficult-to-target ocular tissues. Research has shown that MSC-derived exosomes may offer significant advantages over traditional MSC-based therapies in regenerative medicine. By using exosomes, practitioners can avoid potential risks associated with MSC-centered therapies such as allogeneic immunological rejection, unwanted differentiation, and obstruction of small vessels caused by intravenous MSC injection. These benefits are critical for optimizing treatment outcomes.
  • 363
  • 08 Jun 2023
Topic Review
Mesenchymal Stem Cell-Derived Exosomes in Posterior Segment Diseases
Mesenchymal stem cell (MSC) therapy has shown promise in treating ophthalmic diseases, but suboptimal biocompatibility, penetration, and delivery to the target ocular tissues remain limitations. To address these challenges, researchers have turned to MSC-derived exosomes, which possess properties similar to MSCs and can efficiently deliver therapeutic factors to ocular tissues that are typically difficult to target using conventional therapy and MSC transplantation. Exosomes, small vesicles derived from MSCs, exhibit anti-inflammatory, anti-apoptotic, and immunomodulatory properties, making them an attractive alternative to MSCs for ocular therapy. Due to their nano-size, MSC-derived exosomes can better penetrate biological barriers, such as the blood-retinal barrier, and deliver their cargo effectively to ocular tissues. Moreover, their cargo is protected from degradation, leading to increased bioavailability. As a result, exosomes have great potential for ocular drug-delivery applications. MSC-based therapies in regenerative medicine. Utilizing exosomes could eliminate the risks associated with MSC-centered therapies, such as immunological rejection, unwanted differentiation, and obstruction of small vessels through intravenous MSC injection. Avoiding these risks is critical for optimal treatment outcomes.
  • 265
  • 08 Jun 2023
Topic Review
Mesenchymal Stem Cell-Derived Exosomes in Anterior Segment Diseases
Exosomes, which are derived from MSCs, are nanoparticle vesicles that possess therapeutic properties such as anti-inflammatory, anti-apoptotic, tissue-repairing, neuroprotective, and immunomodulatory functions, much like their parent cells. By using MSC-derived exosomes as a drug-delivery system, their potential advantages can be fully exploited. Due to their ability to penetrate the blood-brain barrier, it is inferred that they may also better penetrate biological barriers such as the blood-retinal barrier. Additionally, their cargo is protected from degradation, resulting in increased bioavailability in ocular tissues. Research suggests that utilizing MSC-derived exosomes as a treatment option could offer several benefits over traditional MSC-based therapies in the field of regenerative medicine. Exosome-based therapy provides an alternative approach that avoids potential risks associated with MSC-centered therapies, such as allogeneic immunological rejection, unwanted differentiation, and obstruction of small vessels caused by intravenous MSC injection. By circumventing these risks, treatment outcomes can be optimized.
  • 216
  • 08 Jun 2023
Topic Review
Overview of Mesenchymal Stem Cell-Derived Exosomes in Ophthalmology
The field of mesenchymal stem cell (MSC) therapy has shown promise in treating ophthalmic diseases. However, MSC-based therapy faces limitations due to suboptimal biocompatibility, penetration, and delivery to the target ocular tissues. To overcome these challenges, researchers have turned their attention to a new aspect of MSCs - their exosomes. These extracellular vesicles possess properties similar to MSCs and can efficiently deliver therapeutic factors to ocular tissues that are typically difficult to target using conventional therapy and MSC transplantation. Exosomes, small vesicles derived from MSCs, exhibit properties such as anti-inflammatory, anti-apoptotic, and immunomodulatory that are similar to their parent cells. These characteristics make exosomes an attractive alternative to MSCs for ocular therapy. Due to their nano-size, MSC-derived exosomes have the potential to better penetrate biological barriers, such as the blood-retinal barrier, and deliver their cargo effectively to ocular tissues. In addition, their cargo is protected from degradation, leading to increased bioavailability. This makes exosomes a promising candidate for ocular drug-delivery applications.
  • 316
  • 08 Jun 2023
Topic Review
Urinary Tract Infection and Microbiome
Urinary tract infection is one of the most common bacterial infections and can cause major burdens, not only to individuals but also to an entire society. Urinary tract infection is not only caused by invading uropathogenic bacteria but also by changes to the uromicrobiome milieu, and interactions with other microbial communities can also contribute. 
  • 266
  • 08 Jun 2023
Topic Review
Finerenone on Cardiovascular and Chronic Kidney Diseases
Patients with cardiovascular disease (CVD) and chronic kidney disease (CKD) show high rates of cardiorenal outcomes. Several studies suggest that the activation of the mineralocorticoid receptor (MR) induces cardiac and renal injury, including inflammation and fibrosis. Finerenone is a novel non-steroidal selective mineralocorticoid receptor antagonist (MRA) with a stronger mineralocorticoid receptor binding potential than eplerenone and spironolactone. Finerenone has been shown to have anti-inflammatory and anti-fibrotic effects in preclinical studies.
  • 359
  • 08 Jun 2023
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