Diagnostic value of Midkine and AFP in the detection of hepatocellular carcinoma: A systematic review and meta-analysis.

Background: Hepatocellular carcinoma (HCC) posed significant health problems and deaths. There are various challenges in the management of HCC, including the late detection or diagnosis. The ongoing diagnostic method in HCC also hinders the detection on the early stages of the disease, thus biomarkers need to be explored further for HCC detection. Serum alpha fetoprotein (AFP) and Midkine (MDK) are two proteins which might be the biomarker of choice in the detection of HCC. This meta-analysis aims to analyze the accuracy of Midkine and AFP in the detection of HCC. Methods: The systematic review and meta-analysis was conducted by adhering to the Preferred Reporting System for Systematic Review and Meta-Analysis (PRISMA) guidelines. We conduct literature screening and selection followed by quality assessment from various databases such as PubMed, MEDLINE, SpringerLink, ProQuest, EBSCOhost, Cochrane, and EMBASE. The included studies were then extracted and analyzed cumulatively using MedCalc and MetaDTA with forest plot and ROC curve as outcome. Results: 12 studies were included in this study. The AFP biomarker yields sensitivity value of 62.5% (97.5% CI 0.442 - 0.778) and specificity value of 95% (97.5% CI 0.842 - 0.986), while the Midkine biomarker denotes sensitivity value of 91.6% (97.5% CI 0.83 - 0.961) and specificity value of 82.2% (97.5% CI 0.83 - 0.96). Conclusions: Both AFP and MDK are proven to be a good diagnostic tool or biomarker in the detection of HCC. The use of both in combination should provide high quality diagnostic marker for HCC suspected patients. Further studies on this should be conducted.

An Efficacy and Safety Comparison of Regorafenib and Nivolumab in Unresectable Hepatocellular Cancer Patients: A Systematic Review.

OBJECTIVE: This systematic review aimed to compare the efficacy and safety of regorafenib and nivolumab, two FDA-approved second-line treatments for unresectable Hepatocellular Carcinoma (HCC). METHODS: Literature comparing the efficacy and safety of regorafenib and nivolumab in unresectable HCC patients was systematically searched across seven databases, including: PubMed, SCOPUS, Cochrane Database of Systematic Reviews, ScienceDirect, EBSCOhost, EMBASE, and ProQuest, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The search was done on April 2nd, 2023. Study quality and risk of bias were assessed using the Agency for Healthcare Research and Quality (AHRQ) and ROBINS-1 tools. The selected studies were included in the qualitative data synthesis. RESULTS: Three trials found that HCC patients taking nivolumab had statistically insignificantly longer OS, TTP, and progression-free survival than those on regorafenib. Nivolumab increased ORR, with largely partial responses, and mixed DCR, with little statistical significance. All three studies showed that nivolumab had fewer side effects and improved tolerance. DISCUSSION: Three retrospective cohort studies with a total of 383 regorafenib-receiving cohorts and 230 nivolumab-receiving cohorts were included in the qualitative analysis. Nivolumab was found to be superior in regards of longer overall survival, longer time to progression, higher objective response rate, and lower adverse event occurrence. However, statistical significance was not achieved in most of the parameters. CONCLUSIONS: The use of nivolumab is preferable as the second-line systemic therapy for unresectable HCC. More high-quality studies are urgently needed to generate quantitative analysis, and to encourage the formation of guidelines for second-line systemic therapy.

The interplay between neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, erectile dysfunction, and Peyronie's disease: A meta-analysis of observational studies.

INTRODUCTION: This study aims to investigate the relationship between Neutrophil- Lymphocyte Ratio (NLR), Platelet-Lymphocyte Ratio (PLR) with Erectile Dysfunction (ED) and Peyronie's disease (PD). METHODS: We conducted a meta-analysis of the observational study by searching for the appropriate keywords in eight databases. The risk of publication bias of the included studies was assessed by Egger's test and Kendall's t. The data extraction was carried out for each study and analysed using Revman 5.0. RESULTS: There were eleven eligible studies out of the 411 studies retrieved. Eight studies were conducted on cases of erectile dysfunction, and three studies on Peyronie's disease. There was a significant relationship between NLR, PLR and ED (SMD: 0.59, 95% CI: 0.33-0.85 and SMD: 0.64, 95% CI: 0.13-1.16, respectively). The same was also found for PD. The active phase of PD tended to have higher NLR (SMD: 0.68, 95% CI: 0.43-0.92) and PLR (SMD: 0.27, 95% CI: 0.06-0.49) compared to the chronic phase. No publication bias was found in both ED and PD studies. CONCLUSIONS: NLR and PLR indicate an ongoing inflammatory process in both ED and PD. These findings can be used as markers of treatment and prognosis of both diseases in sexual health care.

Association between serum midkine levels and tumor size in Indonesian hepatocellular carcinoma patients: a cross-sectional study.

Background: The incidence of liver cancer is increased worldwide with 75%-85% diagnosed as hepatocellular carcinoma (HCC). Current practice has low sensitivity limitations to diagnose the early stages of HCC, thus urging the need for a biomarker with higher sensitivity to detect HCC, specifically in the early stage. This study aimed to determine the association between midkine levels and progressiveness of hepatocellular carcinoma (HCC), according to tumor size, Barcelona Clinic Liver Cancer (BCLC), and presence of portal venous thrombosis. Methods: This cross-sectional study involved 100 patients in Adam Malik General Hospital diagnosed with HCC, collected with a consecutive sampling method, whose diagnoses were confirmed by findings of hypervascular on arterial phase imaging and portal vein or delayed phase washout triple-phase CT Scan. Samples are later categorized according to Barcelona Clinic Liver Cancer (BCLC) stages, tumor size, and presence of portal venous thrombosis. Blood samples were drawn to measure serum midkine using ELISA. Kruskal-Wallis and Mann-Whitney U tests were conducted to determine the difference of midkine levels based on tumor size, BCLC staging, and presence of portal venous thrombosis. Results: Serum midkine level shows a significant difference over tumor size (p=0.014), no significant difference found compared to BCLC stages and presence of portal venous thrombosis. Conclusion: Serum midkine levels are associated with the tumor size of HCC, thus helping physicians determine treatment plans.

Framing and understanding the whole aspect of oral sex from social and health perspectives: a narrative review.

Since thousands of years ago, oral sex has become part of sexual behavior among humans. Oral sex is considered taboo. Its taboo does not lie in the behavior, but its expression is deemed inappropriate. As technology becomes more sophisticated, human rights also stand out, leading to the disclosure of the practice in the 21 st century. The oral sex that is discussed on a large scale in media encourages people to express it as feedback whether within right or not. It all depends on the value of each people. We found that this sexual behavior is found everywhere regardless of religion, culture, and race. Pop culture influences this behavior so much, it can be seen from music, movies, and television programs that provoke oral sex. Many motivations underlying this behavior include getting sexual pleasure for the sake of living well-being. But it is undeniable that this behavior is still controversial. It could be at risk of causing disease and, on the other hand, is reported to provide many benefits.  According to our theory, oral sex is not a new behavior crossing boundaries. It is just an old behavior that surfaces because of the factors that support it. This behavior, which is still considered taboo, has its disadvantages such as sexually transmitted disease but has also benefits such as preventing preeclampsia.

Stem cell therapy and diabetic erectile dysfunction: A critical review.

Erectile dysfunction (ED) has been identified as one of the most frequent chronic complications of diabetes mellitus (DM). The prevalence of ED is estimated to be about 67.4% in all DM cases worldwide. The pathophysiological process leading to ED involves endothelial, neurological, hormonal, and psychological factors. In DM, endothelial and neurological factors play a crucial role. Damages in the blood vessels and erectile tissue due to insulin resistance are the hallmark of ED in DM. The current treatments for ED include phosphodiesterase-5 inhibitors and penile prosthesis surgery. However, these treatments are limited in terms of just relieving the symptoms, but not resolving the cause of the problem. The use of stem cells for treating ED is currently being studied mostly in experimental animals. The stem cells used are derived from adipose tissue, bone, or human urine. Most of the studies observed an improvement in erectile quality in the experimental animals as well as an improvement in erectile tissue. However, research on stem cell therapy for ED in humans remains to be limited. Nevertheless, significant findings from studies using animal models indicate a potential use of stem cells in the treatment of ED.

Inflammatory laboratory findings associated with severe illness among hospitalized individuals with COVID-19 in Medan, Indonesia: a cross-sectional study.

Background: Coronavirus disease (COVID-19) is still a global health problem. COVID-19 patients with severe pneumonia have a higher risk for critical illness, mostly complicated by acute respiratory distress syndrome. The inflammatory response is critical, and the cytokine storm increases severity of COVID-19. Many factors could be associated with a cytokine storm but these are incompletely understood. The aim of this study is to present characteristics of patients with COVID-19 and explore the clinical and inflammatory parameters of severe and critically ill COVID-19 patients in the intensive care unit (ICU). Method: The cross-sectional study was conducted in all severe COVID-19 patients admitted to the ICU. Peripheral blood was taken for laboratory examination within 24 hours of admission. Hematologic parameters, serum electrolyte, renal function, liver function, pancreas enzyme, D-dimer, inflammatory cytokines interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, monocyte chemoattractant protein-1 (MCP-1), and C-reactive protein (CRP) were assessed in this study. Comparison analyses were done between sex, comorbidity existed, body mass index (BMI), and vaccination status. Results: A total of 80 subjects were included in the study. The most frequent comorbidities found among the subjects were obesity (36.35%) and diabetes (22.5%). Only 13.75% of subjects were vaccinated. Laboratory results indicated leukocytosis and neutrophilia, with neutrophil-lymphocyte-ratio (NLR) of 7. The mean inflammatory findings (IL-6, IL-10, TNF-alpha, IFN-gamma, MCP-1), D-dimer, CRP, and lipase increased. Lipase levels were higher in men (p=0.003) and in comorbidity groups. No significant differences found with different BMI groups. Lipase, IL-6, and MCP-1 levels were significantly higher (p=0.019, <0.0001, and 0.03, respectively) in the non-vaccinated group. Conclusions: Most patients with severe COVID-19 have comorbidities and increased inflammatory markers.