约翰·霍普金斯医疗集团总部位于美国马里兰州巴尔的摩市，是一家集医疗、科研、教学于一体的顶尖学术型医疗系统，是美国公认的学术型医疗模式发源地。它将来自约翰·霍普金斯大学医学院等学术及科研组织，与约翰·霍普金斯医院等医疗机构有机整合在一起。作为全球最杰出的医疗体系之一，约翰·霍普金斯经营着六家学术和社区医院，四家市郊卫生保健和手术中心，以及39家初级和专科医疗门诊点。其中，约翰·霍普金斯医院在《美国新闻与世界报道》美国最佳医院评比中常年稳居前列，其中神经科和神经外科、精神病学、耳鼻喉系头颈外科、风湿病科，泌尿科、眼科、肿瘤科等专科表现出色。历史传承约翰·霍普金斯医疗集团的历史可以追溯到1889年——约翰·霍普金斯医院成立的时候。约翰·霍普金斯的使命是树立医疗教育、医学研究以及临床医疗的卓越标准，从而改善社区乃至全人类的健康状况。在近130年的历史中，约翰·霍普金斯创造了医学史上的多项第一，包括第一次录取女性医学生 (1893) 、第一例乳腺癌外科手术 (1889) 、首次分离胰岛素晶体 (1926) ，发现“生物化学剪刀”DNA限制性内切酶 (1970) ，开发第一个有效治疗镰刀型红血球疾病的方法 (1995) 等等。许多今天医院里习以为常的操作，如在外科手术中使用橡胶手套 (1889)、肾透析(1912)、心肺复苏术 (1958)、心律调节器(1972) 等等都是在霍普金斯开始的。约翰·霍普金斯还在2014年公开了一份涵盖人体80%的蛋白质（蛋白质组）的初始目录，成为所有生物医学科学家的公共研究资源。医疗网络作为全球最杰出的医疗体系之一，约翰·霍普金斯经营着六家学术和社区医院 (红色标示)，四家市郊卫生保健和手术中心 (绿色标示)，以及39家初级和专科医疗门诊点 (蓝色标示)。医疗实力约翰·霍普金斯医疗集团拥有全职员工超过4万，每年门诊量超过280万，其中包括大量的疑难病例。约翰·霍普金斯所有医护人员经过严苛的美国医疗体系考核，拥有扎实的专业知识与丰富的临床经验。约翰·霍普金斯各学科专家通过紧密协作，共同确保患者获得最佳的治疗效果与价值体验。 资深诊断专家 确保精准的诊断结果约翰·霍普金斯拥有资深放射影像诊断专家约115名，资深病理诊断专家130名。他们中的很多人不仅均毕业于知名的医学院，而且经过规范的美国住院医生项目的培训且临床实践多年，其中绝大部分诊断专家在全美排名第一的约翰·霍普金斯住院医生规培项目完成临床考核。每位诊断专家专注于1-2个亚专科领域，比如胰腺、肝脏、神经血管等。每一例诊断都会由所涉及的多个亚专科诊断专家共同深入研究，以确保准确的诊断结果。约翰·霍普金斯病理科与放射科共拥有26个临床研究中心, 例如细胞影像研究中心、脑功能影像研究中心、肿瘤转移研究中心、分子基因研究中心等。美国国家卫生研究所向约翰·霍普金斯病理科与放射科赞助的科研经费多年位列全美同类科室研究经费榜首，2017年两个科室共同获得科研经费超过7000万美金。在约翰·霍普金斯，每个月都有研究成果转化为临床实践，进一步完善诊断结果。与此同时，约翰·霍普金斯诊断专家出版了许多权威的教科书，其中包括世界卫生组织蓝皮书，向全世界分享多年的研究成果。多学科会诊 制定个性化治疗方案约翰霍普金斯医院多学科综合治疗门诊是全美第一家多学科综合治疗门诊。约翰霍普金斯开创多学科综合门诊，一方面为了帮助患者节约辗转于各个专科就诊的时间，避免耽误病情；另一方面是将来自不同专科的医生们集中在一起进行会诊，根据患者的临床病理特征、体力状况、家族史以及分子标记物来制定个体化的治疗方案，这既能保证患者能得到最合适的治疗，又能大大节省患者的时间。约翰·霍普金斯拥有40多个亚专科多学科会诊团队，包括动脉瘤、胰腺癌、肺癌、脑癌与脊髓癌等疑难病症。团队中各学科专家会深入研究患者病情，共同制定个性化治疗方案，力求让患者获得最长的生存期及最优的生活质量。以肺癌为例，约翰霍普金斯医院的肺癌多学科诊所可以在一天时间内查看、诊断，并制定肺部治疗计划。在肺癌多学科诊所，患者将会见到包括肿瘤内科医师、放射肿瘤学家、介入性肺病专家、胸外科医生、放射科医师等在内的肺癌医学专家团队，他们会帮助患者对自己的病情和诊断有更完整的理解，并制定出一个最合适的治疗计划。专业质控团队 保障医护质量与患者安全约翰·霍普金斯阿姆斯特朗患者安全与质控中心通过循证医学的方法，研究减少并发症、医疗失误、以及院内感染的措施，并将研究成果转化为日常床边护理的操作标准。该部门拥有超过80位专家。这些专家来自不同的专业领域，比如传染病专家，感染控制专家，微生物专家以及数据分析专家等。他们通力协作制定了许多床边护理的金标准。这些金标准首先在约翰·霍普金斯医院执行，随后向全美乃至全世界其他医院推广，大大减少了血液感染、呼吸机引发的肺炎、导尿管引发的尿路感染、手术创口感染等院内感染的发生。阿姆斯特朗患者安全与质控中心与院内各科室紧密协作，确保所有医护人员严格执行护理标准。约翰·霍普金斯所有临床科室都配备多学科团队，专门负责患者安全与感染控制。该团队能及时发现各科潜在的安全隐患，并制定科学的解决方案，避免对患者造成伤害。同时，阿姆斯特朗患者安全与质控中心对所有临床医护人员进行培训与监督，确保他们充分理解操作标准、熟练使用相关工具，从而使患者风险降到最低。国际医疗礼宾团队 确保愉悦的海外就医体验约翰•霍普金斯医疗国际部拥有全美国最有经验的医疗项目，我们旨在为远道而来的国际患者提供最优质的医疗服务。在您就诊之前、就诊期间和就诊之后，我们的专业团队将为您提供无微不至的照顾，让远在异乡的您就如同在自己家里一样。我们热诚的国际礼宾团队和治疗团队随时乐于为您和您的家人提供个性化、舒适和尊贵的体验。您在约翰•霍普金斯就诊的每个环节，我们都会陪同您，让您可以集中精力治疗。就诊之前：从您第一次咨询开始，我们就会为您安排一位体贴且懂行的国际医疗礼宾员，他将使用您熟悉的中文与您沟通。医疗专家会评估您的病史。您的礼宾员将提供估算费用、核实保险范围、协助付款、安排专家预约、协助做好酒店和地面交通安排，并提供详细日程安排。就诊期间：一位熟悉您本国文化的医疗协调员将陪同您依约就诊，让您在约翰•霍普金斯感到宾至如归。我们的患者体验团队将协助您了解各种服务以及如何使用各种服务，包括国际报刊、互联网访问、特色杂货店、餐馆、商店、银行等。我们的医疗团队已准备好处理任何紧急医疗需求。就诊结束后：您的医疗协调员将确保您从医生那里获得所有必要的病历和医药处方、及随访说明。您将收到一份综合的最终账单，财务专家会为您提供支持并回答任何问题。我们会在您启程离开之前向您提供治疗小结，并在您回家后仍随时提供服务。
Over the past decade, Sub-Saharan Africa has entered a new phase in the evolution of the global syndemic of undernutrition, obesity, and climate change. Earlier reviews, largely based on evidence before 2018, documented the emergence of overlapping nutritional and environmental vulnerabilities. This review provides an updated synthesis of epidemiological evidence published between 2019 and 2025 to capture recent shifts in magnitude, distribution, and interactions of the syndemic components across Africa. Recent data indicate that adult obesity prevalence in the African region reached 12
There is significant heterogeneity related to the use of prophylactic antiseizure medications (ASM) following supratentorial craniotomy. We conducted a systematic review and meta-analysis assessing ASM primary prophylaxis in adults hospitalized following supratentorial neurosurgery with no prior seizure history. The following population, intervention, comparator, and outcome (PICO) questions were assessed: (1) Should ASM versus no ASM be used as seizure prophylaxis in adult patients undergoing supratentorial neurosurgery? (2) If an ASM is used, should levetiracetam (LEV) or phenytoin/fosphenytoin (PHT) be preferentially used? and (3) Should a long (> 7 days) versus short (≤ 7 days) duration of prophylaxis be used? The main outcomes were early seizure (≤ 14 days), late seizures (> 14 days), adverse events, mortality, and functional and cognitive outcomes. We utilized Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to generate recommendations. The initial literature search yielded 1988 articles, and 16 formed the basis of the recommendations. PICO 1: while meta-analysis of randomized controlled trials (RCTs) demonstrated a significant benefit for early seizure prevention, meta-analyses including all study designs was nonsignificant. Further, there were no differences in late seizure or mortality rates, and there was a trend toward higher adverse event rates with ASM. PICO 2: LEV was associated with significantly lower early seizure rates than PHT, and there were trends toward fewer late seizures and adverse events with LEV. PICO 3: only three studies examined the duration of ASM treatment, and there was no significant difference in seizure events between subjects treated for a short versus long duration. We suggest that either prophylactic ASM or no ASM be used for seizure prophylaxis in patients undergoing supratentorial neurosurgery (conditional recommendation, low quality of evidence). If an ASM is used, we suggest LEV over PHT (conditional recommendation, very low quality of evidence) for a short duration (conditional recommendation, very low quality of evidence).
Uterine leiomyomas (ULs) are prevalent benign tumors in women of reproductive age characterized by cellular senescence. Cellular senescence is a state of stable, irreversible cell cycle arrest characterized by discrete changes in cellular morphology and gene expression. This systematic review, following PRIMSA guidelines, evaluated the molecular pathways contributing to senescence in ULs and the use of novel therapeutic agents to target senescence. Two investigators independently screened and identified relevant articles written in English involving human subjects. Sixty-nine articles were identified; 11 studies met criteria. Multiple studies recognized a range of biomarkers of senescence in ULs including senescence associated beta galactosidase (SA-β-gal), senescent associated proteins (p16, p21, p14ARF), and telomere shortening. Key pathways such as AKT and p14ARF-TP53-p21, and genes such as HMGA2 and MED12 have been implicated in regulating the balance between tumor proliferation and growth arrest and senescence. However, the specific genetic and epigenetic mechanisms that induce and maintain senescence in ULs are not fully understood. There is growing interest in investigating whether senescent cells can be therapeutically targeted in ULs by senolytic agents that induce apoptosis, and senomorphic agents that modulate the senescence-associated secretory phenotype (SASP) to reduce its pro-tumorigenic effects. While limited, non-clinical data suggests this approach may be promising, further investigation is needed to establish their clinical efficacy in patients with ULs.
BackgroundThe Lynch syndrome INtegrative Epidemiology And GEnetics (LINEAGE) consortium was established to address gaps in understanding genotype-specific cancer risks and risk-modifiers in contemporary North American Lynch syndrome (LS) populations. LINEAGE is a multi-center, longitudinal cohort to systematically collect data on risk factors, adherence to care, quality of surveillance, and patient-, provider-, and system-level factors associated with incident LS-associated cancers.MethodsLINEAGE recruits individuals with confirmed pathogenic or likely pathogenic variants in LS-associated genes from participating institutions. Data includes retrospective and prospective collection, encompassing clinical abstraction (demographics, surgical history, endoscopic data, treatments), patient-reported surveys (behavioral/lifestyle factors, quality of life, procedures), endoscopist-level data, and biosample metadata. A standardized REDCap database, data harmonization protocols, and a virtual biobank support reproducibility and linkage of clinical data and biosamples. Rigorous quality assurance/quality control processes are embedded for data integrity.ResultsParticipating centers will contribute data to determine gene-specific risks, and gene-environment interactions for Lynch-associated, and other cancers. We will evaluate associations with exposure to, and quality of cancer risk-reduction care, including endoscopic surveillance, risk-reduction surgery, and chemoprevention. The inclusion of provider-level variables, such as endoscopist training and experience, enables unique research into modifiers of post-endoscopy cancer risk. The linked biosample resources will further facilitate mechanistic studies and biomarker discovery.ConclusionsLINEAGE provides a robust platform for advancing LS research by integration of clinical, pathological, epidemiological and genetic data across institutions. Its standardized, collaborative framework enhances the validity and generalizability of risk estimates that will guide decision-making and policy for surveillance to ultimately reduce morbidity and mortality for individuals with Lynch syndrome.
The impact of Whipple Pancreaticoduodenectomy, which involves the resection of the duodenum and partial stomach, on the pharmacokinetic (PK) of venetoclax, is unknown. This case reported the PK parameters of venetoclax in a patient with synchronous acute myeloid leukemia and pancreatic ductal adenocarcinoma, who underwent a Whipple procedure, and was treated with a single dose of venetoclax 400 mg. Due to the limited sampling available, the PK parameters of venetoclax in this patient could not be determined by noncompartmental analysis. We leveraged the existing population pharmacokinetic (POP-PK) model to predict this patient’s concentration–time profile and PK parameters from sparse observed data post hoc. The model-predicted concentration resulted in adequate reconstruction of the patient’s concentration-time profile. Our patient Cmax was approximately 234 µg/L, 5-fold below the Cmax of 1050 µg/L-1077 µg/L as reported for the general population. Despite the expected decrease in systemic exposure due to the Whipple, our patient AUC0-∞ was 20.4 mg*h/L (modeled out to infinity) or 15.4 mg*h/L (absorption truncated at 48 hour), approximately 2-fold below the mean AUC values reported in the literature of 32.8 (±16.9), and 24.3 (1.5 geoSD) mg*h/L, yet well within the population range of values. Overall, Whipple leads to a significant change in the PK characteristics of venetoclax. Change in dosing strategy in patients with a similar clinical profile in order to achieve venetoclax concentrations comparable to the reference population at a single dose of 400 mg is recommended.
