诺福克和诺维奇大学医院

There is conflicting evidence regarding the optimal management strategy for cervical radiculopathy. We conducted a meta-analysis to evaluate the relative effectiveness of nonsurgical treatment and surgical care in adult patients with cervical radiculopathy. We systematically searched PubMed, Embase, and the Cochrane Library to identify randomized controlled trials (RCTs) comparing nonsurgical treatment with surgical treatment. All statistical analyses were performed using RevMan version 5.4. Five RCTs met the inclusion criteria. Surgical treatment significantly improved neck pain (SMD 0.70, 95

Invasive acral Lentiginous Melanoma (ALM) is a distinct subtype of melanoma, primarily affecting non-sun-exposed extremities such as the palms, soles, and nail beds. First described by Reed in 1976. ALM is characterised by lentiginous proliferation of atypical melanocytes along the basal layer of glabrous skin. While “acral melanoma” refers broadly to melanomas arising on acral sites, “acral lentiginous melanoma” specifically denotes this lentiginous subtype. ALM is disproportionately represented among individuals with richly pigmented skin, including Black, Hispanic and Asian populations, in whom it accounts for a higher proportion of melanoma cases than in White populations. Although it represents only 2–3% of all melanomas, ALM carries a poorer prognosis, with five-year melanoma-specific survival rates averaging 80.6%. The pathogenesis of ALM remains incompletely understood. It is not primarily UV-induced but often associated with mechanical stress on weight-bearing or high-friction areas. Recurrent mutations in KIT, NF1, TERT and TP53 are frequently observed, particularly in older and Asian patients, underscoring its distinct molecular profile. Diagnosis is often delayed due to its subtle presentation as irregularly pigmented macules or patches. Histologically, ALM demonstrates lentiginous basal proliferation with dermal invasion. Management typically involves wide local excision, though advanced disease may require lymph node surgery, radiotherapy or systemic therapy. Prognosis is influenced by tumour thickness, ulceration, and sentinel lymph node involvement. Persistent disparities in outcomes highlight the need for improved awareness, earlier diagnosis, and targeted management strategies to address the biological and sociodemographic complexities of ALM.

Health inequity: defined as systematic and avoidable difference in health outcome, remain entrenched across high-income countries, with socioeconomic gaps in life expectancy exceeding 7–10 years. Upstream interventions addressing the social determinants of health are critical. This umbrella review evaluates which macro-level policies and public health interventions most effectively reduce health inequity. We conducted an umbrella review of systematic reviews. Four databases (Embase, Medline, Scopus, Cochrane) were searched from May 2017, the date of the last umbrella review on the subject, to September 2024. Eligible reviews reported population-level interventions in OECD countries, with outcomes stratified by socioeconomic status or related disadvantage. Included systematic reviews were appraised using AMSTAR II. We devised a conceptual Health Equity Pyramid that classified interventions by their agentic demand and population reach. Thirty-five systematic reviews were included. This review evaluated evidence across six policy domains. Redistributive and welfare interventions, including cash transfers, basic income and food subsidies, consistently improved food security, household financial stability and maternal–child health outcomes. Legislative and regulatory measures, such as smoke-free policies and pharmaceutical subsidy reforms, demonstrated robust population-level gains, particularly in disadvantaged groups. Community and housing interventions improved psychological health, reduced morbidity and mortality in targeted populations, and enhanced housing stability. Health system interventions, notably tailored smoking cessation and hospital discharge coordination for people experiencing homelessness, were effective in narrowing disparities. By contrast, educational and behavioural programmes and telehealth interventions often demanded high individual agency; without contextual tailoring, may exacerbate intervention-generated inequality. This umbrella review demonstrates that interventions characterised by low agentic demand: welfare reform, housing support, and legislative measures; yield the most consistent reductions in inequity. High agentic interventions can be effective when carefully tailored to disadvantaged populations but may otherwise exacerbate disparities. Future policy should prioritise structural, population-level strategies to achieve sustainable equity in health outcomes. CRD42024529176.

Abstract We evaluated outcomes by management type for patients with stage IA nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) in the Global NLPHL One Working Group retrospective database of 2243 patients with stages I to IV disease diagnosed from 1992 to 2021 at 38 international institutions. A total of 779 patients had stage IA disease with median age of 35 years (range, 3-89) and median follow-up of 6.1 years. The 6-year progression-free survival (PFS) and overall survival were 86.3% and 97.7%, respectively. Outcomes were analyzed for the 2 groups: complete resection and unresected disease. Patients with a complete resection and observation alone (n = 99) had a 6-year PFS of 65.5% vs 90.5% for those who received radiotherapy (RT) (n = 53). Patients with unresected disease (n = 627; 80.5%) had a 6-year PFS of 62.0% for rituximab alone (n = 31), 89.6% for RT alone (n = 325), 76.8% for ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) alone (n = 40), and 94.3% for ABVD plus RT (n = 130). A total of 127 patients relapsed (16.3%), of which 25 (19.7%) had transformation. Our analysis suggests the following: (1) RT improves the PFS in patients with completely resected disease; (2) rituximab or ABVD alone does not appear to achieve a durable response; and (3) chemotherapy was not observed to add additional PFS benefit when used in combination with RT. Thus, for stage IA NLPHL, RT alone is likely sufficient for definitive treatment.

Surgeries that require one-lung ventilation have high rates of postoperative cardiopulmonary complications with associated morbidity and mortality. Statins may limit inflammation involved in the development of these complications. We tested the hypothesis that perioperative simvastatin use reduces postoperative cardiopulmonary complications, compared with placebo, in surgery requiring one-lung ventilation. Randomised, double-blind, multicentre trial of simvastatin versus placebo in patients undergoing elective oesophagectomy, lobectomy or pneumonectomy at 15 sites throughout the UK. Planned sample size is 452 patients. Participants were randomised to either simvastatin 80 mg or placebo for 4 days preoperatively and up to 7 days postoperatively. The primary outcome measure was a composite endpoint of the incidence of acute respiratory distress syndrome, postoperative pulmonary complications, myocardial infarction and/or myocardial ischaemia during the first 7 days postoperatively or until hospital discharge. A modified intention-to-treat analysis excluded patients who did not receive the intervention preoperatively or proceed with the planned surgery. 251 patients were randomised, 126 assigned to simvastatin and 125 to placebo, with 208 included in the modified intention-to-treat population. The trial was stopped early because of futility following recommendations from the data monitoring and ethics committee. The primary outcome occurred in 45/106 patients (42.5%) in the simvastatin group and 39/102 patients (38.2%) in the placebo group (OR 1.19 (95% CI 0.68 to 2.08); p=0.54). Secondary and safety outcomes were similar between the groups. In patients undergoing one-lung ventilation, simvastatin did not reduce the incidence of postoperative cardiopulmonary complications. isrctn.org identifier, ISRCTN48095567.