Rambam Maimonides Medical Journal最新文献

{"title":"The Expanding Role of the Urologist in Metastatic Prostate Cancer: From Biopsy to Surgical Interventions.","authors":"Nicola Fazaa, Etan Eigner, Ameer Nsair, Melissa Atallah, Gilad Amiel, Azik Hoffman","doi":"10.5041/RMMJ.10564","DOIUrl":"https://doi.org/10.5041/RMMJ.10564","url":null,"abstract":"<p><p>The evolving landscape of metastatic prostate cancer (mPCa) necessitates a redefinition of the urologist's role, extending beyond diagnosis to active participation in therapeutic and surgical management. This review outlines evidence-based approaches to biopsy and surgical interventions across the disease spectrum. Prostate biopsy remains fundamental for diagnosis, treatment stratification, and molecular profiling, with targeted and metastatic lesion sampling improving precision oncology. For symptom relief, surgical management of bladder outlet obstruction through transurethral resection of the prostate and holmium laser enucleation of the prostate remains essential, with emerging data suggesting possible oncologic benefits when combined with systemic therapy. GreenLight photoselective vaporization may represent an alternative option, though evidence remains limited. Cytoreductive radical prostatectomy in carefully selected patients with metastatic hormone-sensitive disease may provide improved local control and delayed progression, supported by growing biological rationale but constrained by the retrospective nature of current evidence. Collectively, these findings underscore the expanding multidisciplinary role of the urologist in mPCa care, emphasizing the need for prospective studies to validate the integration of surgical approaches within systemic treatment frameworks.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Toothache of Rabbi Judah ha-Nasi.","authors":"Yehuda Zadik","doi":"10.5041/RMMJ.10566","DOIUrl":"https://doi.org/10.5041/RMMJ.10566","url":null,"abstract":"<p><p>The Talmud describes several illnesses attributed to Rabbi Judah ha-Nasi, one of the foremost leaders of the Jewish people after the destruction of the Second Temple, and the compiler of the canonical Mishnah. Among these conditions, Tzafedina of the oral cavity is mentioned, characterized by severe and persistent pain lasting for seven years. Although many modern scholars tend to identify this condition with scurvy, the Talmudic accounts of Rabbi Judah's diet and lifestyle do not support a state of nutritional deficiency. Moreover, scurvy is not typically associated with oral pain. Instead, it is more plausible that the term Tzafedina functioned as an umbrella designation for a spectrum of oral disorders, potentially involving the teeth or gingiva. When applied to Rabbi Judah ha-Nasi, the Talmudic narrative appears to emphasize the psychological and symbolic dimensions of suffering. Thus, in addition to the possibility of organic oral pathologies with psychosomatic components that may manifest in the gingiva, the account may also correspond to chronic oral pain syndromes recognized in contemporary oral medicine.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ampullary Neuroendocrine Tumors: Multicenter Experience and Emerging Perspectives on Endoscopic Treatment.","authors":"Federica Fimiano, Lorenzo Dioscoridi, Marta Stegagnini, Edoardo Forti, Francesco Pugliese, Marcello Cintolo, Giulia Bonato, Marianna Bravo, Andrea Palermo, Camilla Gallo, Cecilia Binda, Claudio Zulli, Piera Zaccari, Alberto Mariani, Armando Gabbrielli, Paolo Giorgio Arcidiacono, Massimiliano Mutignani","doi":"10.5041/RMMJ.10562","DOIUrl":"https://doi.org/10.5041/RMMJ.10562","url":null,"abstract":"<p><strong>Background: </strong>Ampullary neuroendocrine tumors (NETs) are extremely rare, representing 0.3%-1% of gastrointestinal NETs and less than 2% of periampullary cancers. Due to their rarity, there is limited data on their natural history, management, and outcomes. Current European Neuroendocrine Tumor Society guidelines (2023) recommend pancreaticoduodenectomy (PD) as the standard treatment. However, this approach is invasive and associated with high morbidity and mortality. Emerging evidence suggests that endoscopic papillectomy (EP) could be a viable alternative in selected cases. This retrospective multicenter study aimed to evaluate the feasibility and outcomes of endoscopic resection for ampullary NETs.</p><p><strong>Methods: </strong>This retrospective case series included 14 patients who underwent EP for ampullary NETs between 2011 and 2022 across three Italian tertiary centers. Pre-procedural evaluation was performed following European Society of Gastrointestinal Endoscopy guidelines. Endoscopic papillectomy was performed under monitored sedation, using standard snares for en bloc resection. Follow-up endoscopy was conducted at a median of 3 months. Primary outcomes included complete resection (R0) and recurrence rates; secondary outcomes focused on adverse events.</p><p><strong>Results: </strong>Fourteen patients (median age: 62.5 years; 50% male) were included. Median tumor size was 18 mm. In 12 out of 14 cases, ampullary NETs were diagnosed only after endoscopic resection. Post-resection histology identified 8 G1 NETs (Ki-67 1%) and 6 G2 NETs (Ki-67 5%). Complete resection was achieved in 11 cases (78.6%). Among 3 incomplete resections, 2 were managed surgically, while 1 was followed up without recurrence. Residual disease was detected in 3 patients: 2 were managed endoscopically, and 1 required surgery. No recurrences occurred during a median follow-up of 14.5 months. Adverse events occurred in 42.9% of patients, including 5 cases of bleeding and 1 case of mild pancreatitis, all resolved without major sequelae. Median hospital stay was 2.5 days.</p><p><strong>Conclusions: </strong>Our findings suggest that EP offers a promising alternative to surgery in selected patients with ampullary NETs. Endoscopic resection was associated with high rates of R0 and favorable short-term outcomes, with effective endoscopic management of residual disease and procedure-related adverse events. Consistent post-procedural surveillance remains essential to detect residual or recurrent disease. Larger prospective studies are warranted to refine patient selection criteria, optimize protocols, and establish the long-term efficacy.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"17 1","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146097473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Formal Education in Leadership and Management for the Practicing Clinician.","authors":"Richard H Savel","doi":"10.5041/RMMJ.10561","DOIUrl":"10.5041/RMMJ.10561","url":null,"abstract":"<p><p>As clinicians progress in their careers, they are often tasked with projects and responsibilities that require additional education, knowledge, and training in leadership and management. In the past, they were expected to pick up these skills along the way; current expectations, however, are different. Today, several avenues are available to clinicians to acquire and refine these competencies. This narrative review provides a structured overview of the education and training available-both with and without formal credentials-and outlines potential opportunities and pathways for developing leadership and management skills, particularly among critical care physicians.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":" ","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12857652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic and Lifestyle Factors Associated with Cardiovascular Risk in a Large Cohort of Spanish Workers.","authors":"Joan Obrador de Hevia, Ángel Arturo López-González, José Ignacio Ramírez-Manent, Carla Busquets-Cortés, Pedro Juan Tárraga López, Miguel García Samuelsson, Pere Riutord-Sbert","doi":"10.5041/RMMJ.10555","DOIUrl":"10.5041/RMMJ.10555","url":null,"abstract":"<p><strong>Background: </strong>Cardiovascular disease is the leading global cause of death, with lifestyle and sociodemographic factors playing key roles in cardiovascular risk (CVR).</p><p><strong>Objective: </strong>This two-phase study assessed the associations of alcohol intake, Mediterranean diet adherence, physical activity, and sociodemographic variables with CVR-as measured by the Registre Gironí del Cor (REGICOR) function and Systematic COronary Risk Evaluation 2 (SCORE2) algorithm-in a large cohort of Spanish workers (Phase 1). A secondary aim was to examine CVR trends from 2010 to 2020 (Phase 2).</p><p><strong>Methods: </strong>A two-phase study was conducted: a cross-sectional analysis of 139,634 workers (Phase 1) and a longitudinal follow-up of 40,431 participants (Phase 2). Anthropometric, clinical, biochemical, and behavioral data were collected using standardized procedures. Multinomial logistic regression was used to evaluate associations.</p><p><strong>Results: </strong>Phase 1 results showed a higher CVR associated with male sex, older age, lower education, manual labor, smoking, physical inactivity, low adherence to the Mediterranean diet, and alcohol consumption. In Phase 2, CVR increased over the decade, especially among smokers, sedentary individuals, and those with lower education.</p><p><strong>Conclusions: </strong>Both modifiable behaviors and structural determinants significantly influence CVR. Preventive strategies should integrate lifestyle promotion with measures to reduce social inequalities, with targeted actions for vulnerable groups.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12591517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the Association Between Smoking and Hyposalivation: A Case-Control Analysis.","authors":"Ambrose Winnifred Christy, Suresh Kumar Bavesh, Thomas Jones Raja Devathambi, Rajasekaran Thanigainathan","doi":"10.5041/RMMJ.10556","DOIUrl":"10.5041/RMMJ.10556","url":null,"abstract":"<p><strong>Background: </strong>Xerostomia, or dry mouth, often intensifies oral health problems like dental caries and periodontitis. Smoking is a key factor influencing salivary flow, potentially leading to these issues. This study assesses the prevalence of xerostomia and reduced salivary flow (hyposalivation) among smokers.</p><p><strong>Materials and methods: </strong>As case and control groups, the study groups include 150 smokers and 150 healthy non-smokers. A detailed questionnaire was used to collect data on smoking behaviors and symptoms associated with xerostomia. A modified Schirmer test was conducted at 1, 2, and 3-minute intervals to measure unstimulated salivary flow. Descriptive statistics were calculated for age, sex, type, frequency, and duration of smoking. The Mann-Whitney test was done to compare the salivary flow between smokers and non-smokers and to compare smoking parameters with salivary flow. Correlation was also determined for salivary flow with age and smoking parameters.</p><p><strong>Results: </strong>All the smokers were males, and most were cigarette smokers (86%). Xerostomia symptoms were reported by 19% of smokers and none by non-smokers, which was statistically significant (P<0.000). Salivary flow rates at 1, 2, and 3 minutes were significantly lower in smokers than in non-smokers. A comparison between the frequency and duration of smoking and salivary flow yielded statistically significant P values of 0.005 and 0.043, respectively. There was a weak negative correlation between age, frequency of smoking, duration of smoking, and salivary flow.</p><p><strong>Conclusion: </strong>This study found a clear association between long-term smoking and xerostomia, with a notable decrease in unstimulated salivary flow. This highlights the adverse effect of smoking on oral health, which could be used in effective counseling for tobacco cessation.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12591518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Narrative Review of Multimodal Data Fusion Strategies for Precision Risk Prediction in Coronary Artery Disease: Advances, Challenges, and Future Informatics Directions.","authors":"Ziqiang Zhou, Jinwen Wang","doi":"10.5041/RMMJ.10558","DOIUrl":"10.5041/RMMJ.10558","url":null,"abstract":"<p><p>Traditional coronary artery disease (CAD) risk scores offer limited precision, often failing to capture the complex, multifactorial nature of the disease. The proliferation of multimodal data from imaging, genomics, electronic health records (EHRs), and wearables offers a transformative opportunity for more individualized risk prediction. This narrative review systematically maps and critically evaluates the landscape of multimodal data fusion for CAD risk prediction. Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we synthesized 39 empirical studies published from 2009 to 2025 to identify key methodological patterns, informatics challenges, and future directions. Our synthesis reveals consistent methodological patterns: (1) integrating imaging biomarkers (e.g. coronary computed tomography angiography, coronary artery calcium scoring) with clinical data robustly enhances risk discrimination and reclassification; (2) adding polygenic risk scores provides incremental value, typically via late-fusion models; and (3) leveraging longitudinal EHR data with machine learning captures dynamic risk trajectories, outperforming static scores. Advanced machine learning architectures, particularly deep and graph neural networks, are pivotal for enabling automated feature extraction and modeling complex cross-modal interactions. Despite these advances, significant informatics hurdles persist, including data heterogeneity, algorithmic bias, the need for robust external validation, and challenges in clinical workflow integration. Multimodal data fusion is a cornerstone of precision cardiology, but realizing its clinical potential requires a concerted focus on developing fair, interpretable, and scalable methodological frameworks to translate complex data into improved patient outcomes.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12591514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Sarcopenia and Frailty in Geriatric Patients with Type 2 Diabetes Mellitus.","authors":"Amtoj Singh Lamba, Monica Gupta, Sarabmeet Singh Lehl, Anita S Malhotra, Uday Pratap Singh Parmar","doi":"10.5041/RMMJ.10554","DOIUrl":"10.5041/RMMJ.10554","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia and frailty are multi-factorial conditions, but few studies have examined their prevalence among older adults with diabetes in the Indian subcontinent. This study aimed to estimate prevalence of sarcopenia and frailty in ambulatory patients ≥65 years with type 2 diabetes mellitus (T2DM).</p><p><strong>Methods: </strong>Sarcopenia was assessed utilizing the Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Frailty was assessed using the Fried Frailty phenotype criteria. The study enrolled ambulatory participants aged 65 years and above with T2DM visiting the outpatient clinic. Patients with degenerative or inflammatory arthritis of the lower limbs, disabling cerebrovascular accidents, Alzheimer's disease or other cognitive impairment, as well as those with chronic obstructive pulmonary disease, chronic liver disease, or chronic kidney disease were excluded from the study.</p><p><strong>Results: </strong>Among the 100 outpatients meeting the inclusion criteria, sarcopenia was present in 30% (including 17% with severe sarcopenia). Frailty was present in 27%, pre-frailty in 59%, and 14% were classified as robust.</p><p><strong>Conclusion: </strong>This study demonstrated a high prevalence of both sarcopenia and frailty among older adults with T2DM. Routine screening for these conditions may facilitate early identification and intervention in this high-risk population.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12591516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Age Meets Atrocity: Medical Realities for Israel's Older Hostages.","authors":"John Adekoya","doi":"10.5041/RMMJ.10559","DOIUrl":"10.5041/RMMJ.10559","url":null,"abstract":"","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12591513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Pulp Stones on Panoramic Radiographs in Patients with Chronic Systemic Diseases: A Cross-sectional Study.","authors":"Shamimul Hasan, Tarun Sharma, Shazina Saeed, Mandeep Kaur, Virender Gombra, Rahnuma Masood","doi":"10.5041/RMMJ.10557","DOIUrl":"10.5041/RMMJ.10557","url":null,"abstract":"<p><strong>Introduction: </strong>Pulp stones (PS) are incidental, mostly asymptomatic, radiographic findings that may hinder endodontic therapy. They are observed as radiopaque aggregates within coronal or radicular pulp tissue on intraoral periapical, bite-wing, panoramic radiographs and cone-beam computed tomography images. This study aimed to evaluate PS prevalence in patients with cardiovascular disease (CVD), diabetes mellitus (DM), and chronic periodontitis (CP) as compared with controls, as a function of age and sex.</p><p><strong>Material and methods: </strong>This cross-sectional study included 200 subjects: 50 healthy controls, and 50 patients each with CVD, DM, and CP. All participants underwent digital panoramic radiograph (orthopantomogram) (OPG) evaluation for the presence/absence, number, and location of PS.</p><p><strong>Results: </strong>Significant differences in PS prevalence were observed among the groups (P<0.01), with CVD patients showing the highest prevalence. Older individuals (>50 years) and first molars were most frequently affected. The maxillary arch showed a significantly higher prevalence than the mandible (odds ratio [OR]=1.45; 95% CI 1.22-1.72). The strongest risk factor was CVD (OR=7.38; 95% CI 5.20-10.47), followed by DM (OR=4.18; 95% CI 2.91-5.99) and CP (OR=4.16; 95% CI 2.88-6.00). Age was significantly associated with PS, while sex showed no association.</p><p><strong>Conclusion: </strong>The presence of PS, even among healthy controls, may serve as an adjunctive radiographic marker and could also alert dental practitioners to the possibility of underlying systemic disease.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"16 4","pages":""},"PeriodicalIF":1.3,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12591515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}