Publications by authors named "Nicholas Syn"

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiac condition, but the risk factors and outcomes of patients with obstructive (HOCM) and non-obstructive hypertrophic cardiomyopathy (NOCM) remain unclear. This systematic review and meta-analysis was conducted to investigate the risk ratio (RR), incidence, and risk factors of all-cause and HCM-specific mortality.

Methods: This PRISMA-adherent systematic review involved a systematic search of PubMed, SCOPUS, and Embase for studies published from 1 January 2001 to 31 August 2023 that reported outcomes of patients with HOCM and NOCM.

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Background: The recently introduced set of terminologies defining categories of steatotic liver disease (SLD) includes metabolic dysfunction-associated SLD (MASLD), alcohol-associated liver disease (ALD), and metabolic dysfunction associated steatotic liver disease and increased alcohol intake (MetALD). The present retrospective cohort study examines clinical characteristics, prevalence, and mortality risk across alcoholic intake spectrum in SLD individuals.

Methods: Data between 1999 to 2018 were extracted from National Health and Nutrition Examination Survey registries and analysed.

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Introduction: The updated consensus introduces "steatotic liver disease" as an umbrella term for all patients with hepatic steatosis, with specific subtypes such as metabolic dysfunction-associated steatotic liver disease (MASLD), MetALD (MASLD with moderate alcohol intake), and alcohol-associated liver disease. Understanding the characteristics and long-term outcomes of these subtypes is essential.

Methods: A systematic review and meta-analysis examined studies published between January 2023 and August 2024 in MEDLINE and EMBASE on liver-related events, cardiovascular outcomes, and mortality across steatotic liver disease subtypes.

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Background And Aims: Alcohol is a major risk factor for cancer development. Our study aimed to provide the updated global, regional and national burden of alcohol-attributable cancer.

Approach And Results: We analysed the Global Burden of Disease Study 2021 to determine the death and age-standardised death rate (ASDR) from alcohol-attributable cancer and the change of these measures between 2000 and 2021 (reflected as annual percent change [APC]), classified by region, nation and country's developmental status, which is based on the sociodemographic index (SDI).

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Introduction: The Iwate difficulty scoring system (DSS) is one of the most widely validated DSS for laparoscopic liver resection (LLR). However, these studies only validated the 4 difficulty levels and did not validate the 12-point difficulty index of the system. To address current limitations in the studies validating the Iwate difficulty scoring system (DSS), we performed an international multicenter study to validate the Iwate DSS across both its four difficulty levels and 12-point difficulty index.

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The 2024 Annual Congress of the International Liver Transplantation Society (ILTS) was from May 1-4 in Houston, Texas, USA, under the theme "Liver Disease and Transplantation: Breaking Barriers and Exploring New Frontiers." In addition to a robust scientific program, the congress also hosted a hands-on cadaveric robotic liver surgery course, a machine perfusion workshop, and a transesophageal echocardiography course. In this report, the ILTS Vanguard and Basic Sciences Committees present a summary of the congress proceedings.

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Background And Aim: The burden of cirrhosis and other chronic liver diseases has changed in recent years due to shifts in the contributing aetiologies. We estimated the burden of cirrhosis and other chronic liver diseases, including etiological and regional differences, across 204 countries and territories from 2010 to 2021.

Approach And Results: We analysed temporal trends in the burden of cirrhosis and other chronic liver diseases utilising data from the Global Burden of Disease Study 2021.

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Background: Vascular endothelial growth factor (VEGF) is overexpressed in nasopharyngeal carcinoma and suppresses the anti-tumour immune response. Previous studies have shown that adding anti-VEGF treatment to PD-1 inhibition treatment strategies improves tumour response. We aimed to compare the efficacy of pembrolizumab, a PD-1 inhibitor, with or without bevacizumab, a VEGF inhibitor, in nasopharyngeal carcinoma.

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Article Synopsis
  • Recent studies indicate that machine learning (ML) algorithms may be useful for predicting patient outcomes after percutaneous coronary intervention (PCI).
  • The review analyzed 11 studies involving nearly 5 million patients and found that while ML models demonstrated high diagnostic accuracy, issues like poor handling of missing data and lack of external validation raise concerns about their reliability.
  • Although ML models show potential as supplemental tools for traditional risk assessments, there are significant hurdles that must be overcome before they can be effectively used in clinical settings.
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  • The study investigates the unclear incidence of cognitive impairment or dementia in patients after coronary artery bypass grafting (CABG) and identifies associated risk factors.* -
  • A systematic search of 23 studies involving 2,620 patients revealed that the incidence of cognitive issues was notably high, especially within the first month and after one year post-surgery, with rates of 35.96% and 39.13%, respectively.* -
  • Hypertension was found to be a significant risk factor for cognitive impairment shortly after CABG, highlighting the need for further research to develop strategies to mitigate these cognitive issues post-surgery.*
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  • Current guidelines for managing asymptomatic severe aortic stenosis (AS) patients are unclear due to insufficient data on their natural history.
  • A systematic review and meta-analysis of 46 studies with 9,545 patients indicated that almost half experienced significant cardiovascular events within 5 years, with many developing symptoms or requiring surgery.
  • The findings highlight the need for better understanding and management strategies for these patients, given their poor long-term cardiovascular outcomes.
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Background: Although the burden of alcohol-associated hepatocellular carcinoma (HCC) is increasing with rising alcohol consumption, clinical presentation and outcomes of alcohol-associated HCC have not been systematically assessed. We aimed to determine the prevalence, clinical characteristics, surveillance rates, treatment allocation, and outcomes of alcohol-associated HCC.

Methods: Medline and Embase were searched from inception to January 2023.

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Background: To overcome the limitations of the term "non-alcoholic fatty liver disease" (NAFLD), the term metabolic-associated steatotic liver disease (MASLD) was introduced. While epidemiologic studies have been conducted on MASLD, there is limited evidence on its associated sex and ethnic variations.

Aims: This study assesses the differences across sex and race-ethnicity on the prevalence, associated risk factors and adverse outcomes in individuals with MASLD.

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Background: Metformin and sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits but their comparative effects on mortality in type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD) are unknown. Hence, we evaluated and compared lifetime benefits arising from metformin or SGLT2 inhibitors in T2DM patients with CVD.

Materials And Methods: Studies published in the PubMed, EMBASE and CENTRAL databases before 28 October 2023 were retrieved.

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  • KRAS mutation negatively impacts survival outcomes for patients with colorectal liver metastases, with those having mutated KRAS showing significantly shorter overall and disease-free survival compared to those with wild-type KRAS.
  • The study analyzed data from 593 patients to compare the effects of R0 (no cancer at margins) and R1 (cancer at margins) resections based on KRAS status, finding that R0 resections benefit wild-type patients but not those with KRAS mutations.
  • In KRAS wild-type tumors, R0 resections were linked to longer survival, while in KRAS-mutated tumors, the resection margin did not influence outcomes, emphasizing the aggressive nature of KRAS-mutated cancers.
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Macrophages are abundant immune cells in the microenvironment of diffuse large B-cell lymphoma (DLBCL). Macrophage estimation by immunohistochemistry shows varying prognostic significance across studies in DLBCL, and does not provide a comprehensive analysis of macrophage subtypes. Here, using digital spatial profiling with whole transcriptome analysis of CD68+ cells, we characterize macrophages in distinct spatial niches of reactive lymphoid tissues (RLTs) and DLBCL.

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Background: Patients with migraines, particularly those with auras, may present with stroke. Atrial fibrillation is a known risk factor for stroke. With common pathophysiological factors between migraines and atrial fibrillation, we aimed to clarify the association between migraine and atrial fibrillation in this systematic review and meta-analysis.

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Article Synopsis
  • - The 2023 Congress of ILTS, ELITA, and LICAGE in Rotterdam was a pivotal event for the liver transplant community, marking a recovery after COVID-19 with 1159 participants and increased abstract submissions.
  • - The conference centered around "Liver Disorders and Transplantation: Innovations and Evolving Indications," covering various topics in Hepatology, Surgical Approaches, and more.
  • - It served as a vital platform for discussions on advancements and collaborative efforts in the liver transplant field, highlighting ongoing innovations and evolving practices.
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Article Synopsis
  • ChatGPT, an AI chatbot from OpenAI, was assessed for its effectiveness in diagnostic histopathology compared to human pathologists in a study that examined its collaborative potential.* -
  • The study revealed that ChatGPT's diagnostic accuracy was inferior to that of pathologists, and while its responses depended on the quality of prompts, it provided limited assistance in diagnosing cases.* -
  • Despite its shortcomings, pathologists acknowledged ChatGPT's utility as an advanced search tool, suggesting that future improvements in AI could enhance its role in histopathology.*
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The scarcity of liver grafts has prompted developments in living donor liver transplantations (LDLT), with previous literature illustrating similar outcomes in recipients compared to deceased donor transplants. However, significant concerns regarding living donor morbidity and mortality have yet to be examined comprehensively. This study aims to provide estimates of the incidence of various outcomes in living liver donors.

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Background: Currently, the outcomes of standard-of-care palliative treatment for BCLM remain poor. Recent literature has shown promising results of hepatic resection, however, not all studies concur. Given the lack of standardized international guidelines in this field, the aim of this study is to provide gold-standard evidence for breast cancer liver metastases (BCLM) through a reconstructed individual patient data meta-analysis approach.

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Background: Emerging data suggest that outcomes for advanced hepatocellular carcinoma (HCC) treated with sorafenib may have improved over time. We aimed to provide robust, time-to-event estimates of survival outcomes for sorafenib in advanced HCC.

Summary: In this systematic review and individual patient data meta-analysis of randomized-controlled trials (RCTs), we searched MEDLINE and Embase from inception till September 2022 for RCTs that provided data for overall survival (OS) and progression-free survival (PFS) for sorafenib monotherapy as first-line systemic therapy for advanced HCC.

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Background: Preliver transplant diabetes mellitus (pre-LT DM) is a common comorbidity in LT recipients associated with poorer post-transplant survival. However, its relationship with other important outcomes, including cardiovascular and renal outcomes, remains unclear. This meta-analysis aims to provide an updated analysis of the impact of pre-LT DM on key post-LT outcomes.

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Article Synopsis
  • Bariatric surgery is a key treatment for severely obese patients with nonalcoholic fatty liver disease (NAFLD), but there is limited data on how different surgical procedures impact histological outcomes related to NAFLD.
  • A meta-analysis of 31 studies found that both foregut bypass and restrictive bariatric procedures significantly improved liver fibrosis, but foregut bypass showed better results for reducing liver fat and body mass index.
  • Foregut bypass also led to lower levels of certain liver enzymes compared to restrictive procedures, suggesting it may be the more effective option for improving metabolic and histological parameters in NAFLD patients.
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Article Synopsis
  • The study investigates the long-term risks associated with metabolic dysfunction-associated steatotic liver disease (MASLD) by analyzing data from 129 original studies comparing MASLD patients to those without the condition.* -
  • Results indicate that individuals with MASLD have a higher risk of various complications, including cardiovascular issues, metabolic disorders (like diabetes and hypertension), chronic kidney disease, and certain cancers, with those having advanced liver disease at an even greater risk.* -
  • The findings highlight the need for comprehensive treatment approaches for MASLD due to its serious multisystem effects on health.*
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