Michigan Surgical Hospital

Artificial sweeteners (AS) are widely used as sugar substitutes, particularly among individuals with metabolic disorders. Although AS are approved by regulatory authorities, concerns regarding their potential association with cancer risk persist due to inconsistent findings across studies. This umbrella review aimed to comprehensively synthesize evidence from published meta-analyses evaluating the association between AS consumption and cancer risk. A systematic search of PubMed, Web of Science, and Scopus was conducted to identify meta-analyses examining the association between AS consumption and cancer outcomes in human populations. Data synthesis was performed using random-effects models, and evidence certainty was evaluated using the GRADE framework. Sensitivity analyses, prediction intervals, and publication bias assessments were conducted when applicable. Overall AS consumption was not significantly associated with breast cancer (OR = 0.99, 95% CI 0.92–1.08, P = 0.99), colorectal cancer (CRC) (OR = 0.90, 95% CI 0.76–1.05, P = 0.18), pancreatic cancer (OR = 1.04, 95% CI 0.93–1.17, P = 0.44), gastric cancer (OR = 0.93, 95% CI 0.63–1.36, P = 0.71), or bladder cancer (OR = 1.19, 95% CI 0.75–1.88, P = 0.44). Dose-specific analyses showed no significant associations between AS consumption and breast cancer across low-dose (OR = 1.00, 95% CI 0.95–1.06, P = 0.83), moderate-dose (OR = 0.97, 95% CI 0.94–1.01, P = 0.21), or high-dose categories (OR = 0.88, 95% CI 0.73–1.06, P = 0.18). For CRC, low-dose AS consumption was associated with a reduced risk (OR = 0.87, 95% CI 0.76–0.99, P = 0.04; GRADE: low), whereas moderate-dose (OR = 1.11, 95% CI 0.92–1.33, P = 0.25) and high-dose AS consumption (OR = 0.89, 95% CI 0.79–1.00, P = 0.05) showed no significant associations with CRC risk. Based on the GRADE framework, the certainty of evidence was rated as low for breast cancer, CRC, and pancreatic cancer, very low for bladder cancer, and not assessable for gastric cancer due to the limited number of studies. Although no significant cancer risks were identified, the overall strength of the evidence was weak. More well-designed, high-quality studies are necessary to further explore and clarify the long-term impact of AS on cancer risk. Additionally, there is insufficient evidence available to assess the effects of AS on other cancer types, and further research is needed in this area.

Radiation necrosis (RN) presents a significant challenge in the treatment of pediatric central nervous system tumors. This narrative review synthesizes current evidence on the use of bevacizumab (BEV) for managing pediatric RN, drawing from case reports, retrospective reviews, and prospective clinical trials. While high-quality prospective data remain limited, emerging evidence suggests that BEV may be effective in alleviating both clinical symptoms and radiographic manifestations of RN in pediatric patients. This review explores the pathophysiology of RN, BEV’s mechanism of action, and existing evidence on the use of BEV in pediatric RN. Emerging evidence suggests that bevacizumab may provide symptomatic relief and radiographic improvement in pediatric patients with RN. By addressing current knowledge gaps, the aim is to provide insight into the potential role of BEV in improving outcomes for pediatric patients with RN.

Synovial chondromatosis is a rare, generally benign condition characterized by the formation of multiple cartilaginous nodules in the synovium of joints and occasionally on the tendon sheath or bursae. If the nodules are intra-articular, the condition is referred to as synovial chondromatosis; if extra-articular, tenosynovial chondromatosis. This space-occupying lesion can lead to chronic pain and limit the function of involved joints. We report a case of synovial chondromatosis involving the subtalar joint and tenosynovial chondromatosis involving the posterior ankle and review current definitions of this uncommon lower-extremity condition.

The incidence of bladder cancer has grown over the years, presumably in part because of increasing exposure to carcinogenic agents in modern-day life. Drs Badalament and Schervish outline the latest diagnostic and staging methods for the disease and summarize treatment options for superficial, invasive, and metastatic cancers, including discussion of various methods for urinary diversion following cystectomy.

Over the past generation, advents in topical antibiotics and oral analgesia have obscured butamen and its family of topical anesthetics. Using a modified version of the McGill University pain questionnaire, this study attempts to establish the efficacy and clinical utility of this overlooked topical anesthetic.