bluuebunny/crossref_metadata_2025 huggingface dataset:
The obesity paradox and orthopedic surgery
Authors: Hennrikus Matthew , Hennrikus William P. , Lehman Erik , Skolka Michael , Hennrikus Eileen
Published: August 2021

The Obesity Paradox describes the counterintuitive finding that although obesity contributes to the development of chronic conditions such as chronic kidney disease and cardiovascular disease, obesity seems to improve mortality in patients with these diseases. This paradox has also been sited in the critical care literature in regard to acute kidney injury, obesity and mortality. This study's objective is to examine the impact of obesity and post-surgical acute kidney injury on hospital length of stay and 2-year mortality after orthopedic surgery.

We reviewed the electronic medical records of all adult elective orthopedic surgery patients over 2 years in a large academic hospital. The 1783 patients who met inclusion criteria were divided into obese (body mass index, BMI ≥ 30, n = 1123) and non-obese groups (BMI <30, n = 660). Demographics, medications, comorbidities, and perioperative variables were included in multivariable logistic regression analyses with acute kidney injury, length of hospital stay, and two-year mortality as primary outcomes. Outcomes were analyzed for the entire group, the obese cohort and the non-obese cohort.

Acute kidney injury developed in 5% of the post-surgical orthopedic patients. Obesity increased the likelihood of developing acute kidney injury post orthopedic surgery (odds ratio [OR] = 1.82; 95% Confidence interval [CI] 1.05–3.15, P = .034). Acute kidney injury increased length of stay by 1.3 days and increased the odds of two-year mortality (OR = 2.08; 95% CI 1.03–4.22, P = .041). However, obese patients had a decreased likelihood of two-year mortality (OR = 0.53; 95% CI 0.33–0.84, P = .009).

In adult orthopedic surgery patients, obesity increased the risk of acute kidney injury. Patients who developed an acute kidney injury had longer hospital stays and higher two-year mortality. Paradoxically, obesity decreased two-year mortality.
Association of gastroesophageal reflux disease with increased risk of chronic otitis media with effusion in adults
Authors: Yeo Cha Dong , Kim Jong Seung , Lee Eun Jung
Published: August 2021

This study aimed to evaluate the risk of developing chronic otitis media with effusion (OME) in individuals with gastroesophageal reflux disease (GERD).

A retrospective propensity score-matched cohort study was performed using data from the Korea National Health Insurance Service. The GERD group (n = 3532) included certain individuals who had been diagnosed with GERD between January 2002 and December 2005. A comparison control group (n = 14,128) was calculated by 1:4 propensity score matching considering age, sex, and comorbidities and year of enrollment. Each patient was monitored until 2013. Survival analysis, the Log-rank test, and Cox proportional hazard regression models were used to calculate the incidence, survival rate, and hazard ratio (HR) of chronic OME for each group.

Among the 17,660 individuals included in the study population (53.2% men), the overall incidence of chronic OME during the 11-year follow-up was 1.84-fold higher in the GERD group than in the non-GERD group (1.8 vs 3.0 per 1000 person-year; adjusted HR 1.84; 95% confidence interval [CI], 1.46–2.31). Moreover, the adjusted HRs of developing chronic OME (allergic rhinitis, 1.69 [95% CI, 1.37–2.10]; asthma, 1.29 [95% CI, 1.02–1.64]; chronic rhinosinusitis, 1.61 [95% CI, 1.26–2.05]) were greater in study population with comorbidities.

From long-term follow-up, the prevalence of chronic OME in adults was 1.84 times higher in the GERD group compared with the non-GERD group. Specifically, it found that allergic rhinitis, asthma, or chronic rhinosinusitis showed increase the risk of developing chronic OME than those without these conditions.
Evaluation of the distance from the anterior cervicovaginal junction to the anterior peritoneal reflection for anterior colpotomy during vaginal hysterectomy in Korean women
Authors: Lee Ji Hye , Chae Su Hyun , Lee A. Jin , Min Yoon Jung , So Kyeong A. , Lee Sun Joo , Kim Tae Jin , Shim Seung-Hyuk
Published: August 2021

This study aimed to know the distance of the cervicovaginal junction (CVJ) to the anterior peritoneal reflection (APR) as measured in surgical specimens, and assess the distance between the CVJ and APR to ensure safe anterior colpotomy for vaginal hysterectomy among Korean women.

Patients who underwent vaginal hysterectomy were included in the analysis. According to the presence of pelvic organ prolapse or menopausal status, the distance from the CVJ to the APR was assessed preoperatively through transvaginal ultrasonography (TV-US), as well as intraoperatively using surgical specimens. The intraclass correlation coefficient was used to determine the reliability between 2 measurements.

In total, 171 patients were included. The median distance from the CVJ to the APR measured on TV-US was 19.8 (3.3–41.3) mm. Meanwhile, the median distance from the CVJ to the APR measured using the surgical specimen was 26.0 (12.0–55.0) mm. The intraclass correlation coefficient for the absolute agreement between 2 measurements was 0.353 (95% confidence interval: 0.002–0.570; P < .001), which is indicative of poor reliability. The median distance from the CVJ to the APR measured using the surgical specimen did not differ significantly between the 2 groups according to pelvic organ prolapse (26.0 [12.0–55.0] vs 27.5 [17.0–55.0] mm, P = .076] and menopausal status (27.0 [15.0–55.0] vs 26.0 [12.0–55.0] mm, P = .237).

TV-US does not an accurately measure the dissection plane length from the CVJ to the APR during anterior colpotomy. During vaginal hysterectomy, the median distance from the CVJ to the APR measured using the surgical specimen was 26 (12.0–55.0) mm, which can help decrease surgical complications.
A novel immune signature to predict the prognosis of patients with hepatocellular carcinoma
Authors: Li Qinghe , Fan Bin , Ding Jun , Xiang Xiaoxi , Zhang Jian
Published: August 2021

Aberrant immunity has been associated with the initiation and progression of cancers such as hepatocellular carcinoma (HCC). Here, we aim to develop a signature based on immune-related genes (IRGs) to predict the prognosis of HCC patients. The gene expression profiles of 891 HCC samples were derived from 4 publicly accessible datasets. A total of 1534 IRGs from Immunology Database and Analysis Portal website were obtained as candidate genes for prognostic assessment. Using least absolute shrinkage and selection operator (LASSO) regression analysis, 12 IRGs were selected as prognostic biomarkers and were then aggregated to generate an IRG score for each HCC sample. In the training dataset (n = 365), patients with high IRG scores showed a remarkably poorer overall survival than those with low IRG scores (log-rank P < .001). Similar results were documented in 3 independent testing datasets (n = 226, 221, 79, respectively). Multivariate Cox regression and stratified analyses indicated that the IRG score was an independent and robust signature to predict the overall survival in HCC patients. Patients with high IRG scores tended to be in advanced TNM stages, with increased risks of tumor recurrence and metastasis. More importantly, the IRG score was strongly associated with certain immune cell counts, gene expression of immune checkpoints, estimated immune score, and mutation of critical genes in HCC. In conclusion, the proposed IRG score can predict the prognosis and reflect the tumor immune microenvironment of HCC patients, which may facilitate the individualized treatment and provide potential immunotherapeutic targets.
The antioncogenic effect of Beclin-1 and FOXP3 is associated with SKP2 expression in gastric adenocarcinoma
Authors: Kim Hyung Kyung , Won Kyu Yeoun , Han Sang-Ah
Published: August 2021

An overexpression of S-phase kinase-associated protein 2 (SKP2) is frequently observed in human cancer progression and metastasis, and evidence suggests that SKP2 plays a proto-oncogenic role both in vitro and in vivo. However, the function of SKP2 in gastric adenocarcinoma remains largely obscure. We investigated SKP2 expression in human gastric carcinomas.

Tissue samples were acquired from 182 cases of gastric adenocarcinoma that were surgically resected from 2006 to 2012. Immunohistochemical staining for SKP2, Beclin-1, and forkhead box protein P3 (FOXP3) was performed. Pearson chi-square test was used to evaluate the associations among clinicopathological variables. The Kaplan–Meier method, the log-rank test, and the Cox proportional-hazards model were used in the analysis of the overall survival (OS) and disease-free survival (DFS).

As a result, SKP2 overexpression in gastric adenocarcinomas showed a significant correlation with several favorable clinical factors, including the tumor size, T category, N category, lymphatic invasion, vascular invasion, OS, and DFS. SKP2 expression was positively correlated with the tumoral FOXP3, Beclin-1 expression, and regulatory T cell (Treg) infiltration. The difference in DFS between the SKP2 positive and negative group was attenuated by FOXP3 high expression, Beclin-1 high expression, and Tregs infiltration. Attenuation of the difference in OS by FOXP3 high expression, Beclin-1 high expression, and Tregs infiltration was not significant. In multivariable analysis, SKP2 expression was not correlated with OS and DFS.

Our study showed a complex interrelationship between SKP2 and Beclin-1 and FOXP3 expression in gastric adenocarcinoma. The antioncogenic effect of Beclin-1 and FOXP3 expression in gastric adenocarcinoma is related to SKP2 expression.
A comparison of quality of life between patients with small and large gastric remnant volumes after gastrectomy for gastric cancer
Authors: Min Jae-Seok , Jeong Sang-Ho , Park Ji-Ho , Kim Taehan , Jung Eun-Jung , Ju Young-Tae , Jeong Chi-Young , Kim Ju-Yeon , Park Miyeong , Lee Young-Joon
Published: August 2021

The impact of gastric remnant volumes (GRVs) after gastrectomy on patients’ quality of life (QOL) has not yet been clarified. The aim of the present study was to compare QOL after gastrectomy between small and large gastric remnant volume patients.

We prospectively collected clinical data from 78 consecutive patients who underwent distal gastrectomy with Billroth II gastrojejunostomy for gastric cancer. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Stomach questionnaire and gastric computed tomography scans were performed. The patients were subdivided into 2 groups by remnant stomach volume (the S group ≤110 mL vs L group >110 mL).

The worst scores for most items were observed at postoperative month 1 and usually improved thereafter. There was no difference in the STO22 score except for dysphagia between the S and L groups after gastrectomy (P > .05). The QOL score of dysphagia was different at postoperative 6 months (S vs L, 12.4 vs 22.8, P < .03), but there was no difference at postoperative months 1, 3, 12, 24, or 36 (P > .05).

The remnant gastric volume after partial gastrectomy affects neither functional differences nor QOL after 6 months following appropriate radical surgery.
Transarterial chemoembolization plus sorafenib versus sorafenib for intermediate–advanced hepatocellular carcinoma
Authors: Xie Yong , Tian Huan , Xiang Bin , Zhang Yongjin , Liu Jian , Cai Zhuoyan , Xiang Hua
Published: August 2021

Background:

Hepatocellular carcinoma (HCC) ranks as the sixth most common cancer and the second leading cause of cancer-related death worldwide, local and systemic therapies are beneficial for those who have more advanced disease or are not suitable for radical treatment. We aim to investigate the clinical outcomes of transarterial chemoembolization (TACE) plus sorafenib compared with sorafenib monotherapy for intermediate–advanced HCC.

Methods:

A systematic search according to preferred reporting items for systematic reviews and meta-analyses guidelines in the PubMed database was conducted from inception to December 31, 2020 for published studies comparing survival outcomes and tumor response between TACE + sorafenib and sorafenib alone for intermediate–advanced HCC.

Results:

Five eligible cohort studies and a randomized controlled trial with a total of 3015 patients were identified. We found that the TACE + sorafenib group had a significantly better overall survival (OS) (hazard ratio, 0.77; 95% confidence interval [CI] 0.66–0.88, P < .001) than those treated with sorafenib. Median OS ranged from 7.0 to 22.0 months with TACE + sorafenib and from 5.9 to 18.0 months with sorafenib. The combination of TACE + sorafenib had a significantly better time to progression (hazard ratio, 0.74; 95% CI 0.65–0.82, P < .001) than those treated with sorafenib. Median time to progression ranged from 2.5 to 5.3 months with TACE + sorafenib and from 2.1 to 2.8 months with sorafenib. The results showed the TACE + sorafenib group had a higher disease control rate (log odds ratio, 0.52; 95% CI 0.25–0.80, P = .0002), objective response rate (log odds ratio, 0.85; 95% CI 0.37–1.33, P = .0006) than sorafenib group. Hand–foot skin reaction, diarrhea, fatigue, vomiting, and alanine aminotransferase (ALT) elevation were common adverse events. The adverse events were similar between the 2 groups excluding elevated ALT.

Conclusion:

Although the TACE + sorafenib group had a higher elevated ALT, the combination of TACE + sorafenib had an OS benefit compared with sorafenib in the treatment of intermediate–advanced HCC. Further research is necessary to affirm this finding and clarify whether certain subgroups benefit from different combinations between TACE and sorafenib.
Bioinformatics analysis of constructing a HCV-related hepatocellular carcinoma miRNA–mRNA regulation network
Authors: Hao Rui , Lu He , Guo Yanan , Liu Qianqian , Wang Lu , Wang Yang , Huang Ailong , Tu Zeng
Published: August 2021

Hepatocellular carcinoma (HCC) is one of the tumors with a higher mortality rate globally, which significantly threatens people's health. Hepatitis C virus (HCV) infection is a major driving factor of HCC. This study aims to determine the key microRNA (miRNA), hub genes, and related pathways, construct potential miRNA–mRNA regulatory networks, and clarify the new molecular mechanism of HCV-related HCC. In this study, 16 differentially expressed miRNAs (DE miRNAs) were identified. The prediction of potential transcription factors and target genes not only found that SP1 and ERG1 may potentially regulate most of the screened DE miRNAs, but it also obtained 2923 and 1782 predicted target genes for the up-regulation and down-regulation of DE miRNAs, respectively. Subsequently, the introduction of differentially expressed genes dataset GSE62232 for target gene verification yielded 98 and 147 potential up-regulation and down-regulation target genes. The gene ontology (GO) and Kyoto encyclopedia of genes and genomes pathway enrichment analysis showed that they were mainly enriched in the cell cycle process, that is, subsequently, 20 hub genes were screened out through the protein–protein interaction network, and related genes were further evaluated using the GEPIA database. Based on the above analysis, the miRNA-hub gene regulatory network was constructed. In short, this research's hub genes and miRNAs closely related to HCV-related HCC were screened and identified through bioinformatics analysis and then built their connection. These results are expected to find potential therapeutic targets for HCV-related HCC.
Breast reconstruction during the COVID-19 pandemic
Authors: Sun Pengfei , Luan Fang , Xu Di , Cao Rui , Cai Xia
Published: August 2021

Background:

The novel coronavirus disease 2019 (COVID-19) has changed people's way of life and posed great challenges to plastic surgery. Most of plastic surgeries are considered elective surgeries and are recommended to be delayed. But breast reconstruction in plastic surgery is special. Doctors’ associations from different countries have different rules on whether breast reconstruction surgery should be delayed. For the controversial topic of immediate breast reconstruction in the COVID-19 pandemic, we conducted this study.

Methods:

We searched English databases such as PubMed, Cochrane Library, and Embase. The publication time of papers was set to be from the establishment of the databases to February 2021. All studies on immediate breast reconstruction in the COVID-19 pandemic were included in our study.

Results:

A total of 6 studies were included in this study. Four studies recommended the use of breast implants or tissue expansion for breast reconstruction surgery and had good results in their clinical practice. In addition, 1 study planned to use autologous free tissue transfer for breast reconstruction, and 1 study planned to use microsurgical techniques for breast reconstruction. But these 2 technologies are still in the planning stage and have not yet been implemented.

Conclusions:

In our opinion, breast cancer surgery belongs to confine operation, and breast reconstruction surgery should be performed immediately after the completion of breast cancer surgery. We recommend the use of breast implants for breast reconstruction surgery during the COVID-19 epidemic. Due to the limitations of the study, our proposed protocol for breast reconstruction surgery during the COVID-19 epidemic needs to be further validated in clinical studies.
Mapping of endometriosis in patients with unilateral endometrioma
Authors: Araujo Raquel Silveira da Cunha , Maia Sabina Bastos , Lúcio Juliane Dornelas , Lima Moisés Diogo de , Ribeiro Helizabet Salomão Abdalla Ayroza , Ribeiro Paulo Augusto Ayroza Galvão
Published: August 2021

To map the distribution of the sites most affected by endometriosis in patients with unilateral ovarian endometriomas.

A descriptive case series of 84 patients with unilateral endometriomas undergoing laparoscopy for the treatment of endometriosis. To evaluate the distribution of the sites of endometriosis lesions, the peritoneal compartments were divided into 5 zones: zone 1/the anterior compartment, including the anterior uterine serosa, vesicouterine fold, round ligament, and bladder; zone 2/the lateral compartment, including the left and right ovary, ovarian fossa, tubes, mesosalpinx, uterosacral ligaments, parametrium, and the ureter; zone 3/the posterior compartment, including posterior uterine serosa, the pouch of Douglas, posterior vaginal fornix, and bowel; zone 4 consisting of the abdominal wall; and zone 5 consisting of the diaphragm.

Of the 5 zones evaluated, the lateral compartment (zone 2) was the most affected, with 60.7% of the patients having dense adhesions around the left ovarian fossa and 57.1% around the right ovarian fossa. The ovarian endometriomas were more commonly found on the left side (54.8%) compared to the right (45.2%). In the posterior compartment (zone 3), the posterior cul-de-sac was obliterated in 51.2% of the patients. In the anterior compartment (zone 1), there were lesions in the vesicouterine fold in 30.9% of the patients and in the bladder in 19%. Lesions were found in the abdominal wall (zone 4) and diaphragm (zone 5) in 21.4% and 10.7% of patients, respectively.

Unilateral endometriomas are important markers of the severity of endometriosis.
Relationship between alcohol consumption and the risks of liver cancer, esophageal cancer, and gastric cancer in China
Authors: He Fengdie , Sha Yuting , Wang Baohua
Published: August 2021

Objective

: To study the correlation between alcohol consumption and the risks of liver, esophageal squamous cell carcinoma (ESCC), and gastric cancers in China mainland by meta-analysis.

Methods

: We systematically searched electronic databases to identify the case–control studies that reported the association between alcohol consumption and the risks of liver, ESCC, and gastric cancers from January 1, 2010 to April 1, 2020. The Newcastle–Ottawa Scale (NOS) was used to evaluate literature quality, and I

2
analyzes were used to evaluate the heterogeneity.

Results

: A total of 2855-related studies were retrieved. After conditional screening, we included 26 case–control studies for meta-analysis. Meta-analysis showed that alcohol consumption was associated with increased risks of liver, ESCC, and gastric cancers (total pooled odds ratio [OR], 1.83; 95% confidence interval [CI], 1.58–2.11; liver cancer OR, 1.83; 95% CI, 1.39–2.40; ESCC OR, 2.00; 95% CI, 1.66–2.40; gastric-cancer OR, 1.54; 95% CI, 1.10–2.15). Subgroup analysis results showed that the pooled ORs of volume of alcohol consumed, years of drinking, age of starting drinking, and drinking status were 1.71 (95% CI, 1.36–2.15), 1.65 (95% CI, 1.33–2.06), 1.38 (95% CI, 0.98–1.94), and 2.00 (95% CI, 1.42-2.81), respectively. Regression analysis showed that geographical region was a source of heterogeneity.

Conclusion

: Alcohol consumption increased the risks of liver cancer, ESCC, and gastric cancers in China. Volume of alcohol consumed, years of drinking, age of starting drinking, and drinking status were all significant factors for these risks.
Estimation of pulmonary artery pressure with transesophageal echocardiography
Authors: Mora Bruno , Roth Dominik , Bernardi Martin H. , Base Eva , Weber Ulrike
Published: August 2021

With the declining use of the pulmonary artery catheter (PAC), transesophageal echocardiography (TEE) has become an appealing alternative to obtain pulmonary artery pressure non-invasively using the simplified Bernoulli equation. The validation of this method in the perioperative setting has been scarce with no clear recommendations about which view is the most accurate to estimate right ventricular systolic pressure (RVSP).

Therefore, we performed a prospective, observer-blinded, diagnostic test accuracy study to assess the difference in systolic pulmonary artery pressure (sysPAP) measuring both, invasively sysPAP and estimated RVSP with TEE in 3 different views: the mid-esophageal (ME) 4Chamber, the ME right ventricular (RV) inflow-outflow and the ME modified bicaval view.

To show a clinically significant difference of at least 10% in RVSP, we included 40 cardiac surgical patients divided into 3 subgroups: Patients with mild to moderate tricuspid regurgitation (TR) and mean PAP <25 mm Hg, patients with mild to moderate TR and mean PAP≥ 25 mm Hg, and patients with severe TR.

For the whole cohort, bias of estimated RVSP compared to measured sysPAP was 5.27 mm Hg, precision was 7.96 mm Hg, limits of agreement were −10.66 to 21.19 mm Hg. The best agreement between the 2 methods was found in patients with severe TR and in the ME RV inflow-outflow and the modified bicaval view. Good Doppler signals were available in 35% and 46% in these views, and in 20% in the ME 4 chamber view.

The estimation of the sysPAP by TEE cannot be considered reliable in the clinical perioperative setting. Only measurements that provide a full Doppler envelope show sufficient precision to provide accurate estimations.
Prevalence of postoperative delirium with different combinations of intraoperative general anesthetic agents in patients undergoing cardiac surgery
Authors: Shin Hyun-Jung , Choi Soo Lyoen , Na Hyo-Seok
Published: August 2021

Postoperative delirium (PD) remains an issue in cardiac surgery despite the constant efforts to reduce its incidence. In this retrospective study, the incidence of PD was evaluated in patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) according to different primary anesthetic agents: sevoflurane and dexmedetomidine- versus propofol-based anesthesia.

A total of 534 patients who underwent heart-valve surgery or coronary artery bypass graft surgery with CPB between January 2012 and August 2017 were divided into 2 groups according to the main anesthetic agent: sevoflurane with dexmedetomidine (sevo-dex group, n = 340) and propofol (propofol group, n = 194). The incidence of PD was evaluated as the primary outcome. Patient-, surgery-, and anesthesia-related factors and postoperative complications were investigated as secondary outcomes. To reduce the risk of confounding effects between the 2 groups, 194 patients were selected from the sevo-dex group after propensity-score matching.

After propensity-score matching, the incidence of PD was not significantly different between the sevo-dex (6.2%) and propofol (10.8%) groups (P = .136). In comparisons of the incidence of each type of PD, only hyperactive PD occurred significantly less frequently in the sevo-dex group (P = .021). Older age, lower preoperative albumin levels, and emergency surgery were significant risk factors for PD.

The overall incidence of PD after cardiac surgery with CPB did not differ between patients receiving sevoflurane and dexmedetomidine-based versus propofol-based anesthesia. Only hyperactive PD occurred less frequently in patients receiving sevoflurane and dexmedetomidine-based anesthesia.
Intrasubject relationship between striatal 18F-FP-CIT uptake and cardiac 123I-MIBG uptake differs by motor subtype in early Parkinson disease
Authors: Jang Wooyoung , Lee Ji Young , Kim Ji Young , Lee Soo Jin , Kim Tae Yoon , Choi Yun Young , Kim Hee-Tae , Kim Chun K.
Published: August 2021

Parkinson disease (PD) is a heterogeneous neurodegenerative disorder. Dopamine transporter imaging using 123I-2β-carbomethoxy-3β-(4-iodophenyl)-N-(3-fluoropropyl)-nortropane (FP-CIT) and noradrenergic cardiac imaging using 123I-meta-iodobenzylguanidine (MIBG) have been used in combination or separately to study PD patients. Published results regarding uptake of the 2 tracers in each motor subtype are fairly abundant and mostly in agreement. However, data on the intrasubject association between dopaminergic and noradrenergic systems in PD patients are relatively scant and vary. We aimed to assess the intrasubject relationship between striatal dopamine transporter density using a PET tracer and cardiac sympathetic innervation in tremor-dominant subtype (TD) and akinetic-rigid subtype (AR) of PD.

This study has a cross-sectional design. Thirty-one patients with early PD (17 TD/14 AR) who underwent both 123I-MIBG cardiac scintigraphy and 18F-FP-CIT PET/CT were retrospectively selected. We assessed the relationship between heart-to-mediastinum ratio (H/M) of 123I-MIBG and specific (striatal)-to-nonspecific (cerebellar) dopamine transporter binding ratio (S/N) measured from 4 separate regions-of-interest (bilateral caudate nuclei and lentiform nuclei) of 18F-FP-CIT in each motor subtype.

S/N of all 4 striatal regions were significantly lower in the AR subgroup than in the TD subgroup. H/M was not significantly different. There was a significant intrasubject correlation between H/M and S/N of the lentiform nucleus in AR-PD but no correlation between H/M and any of 4 S/N in TD-PD.

Our data suggest a coupled degeneration of nigrostriatal dopaminergic and myocardial sympathetic denervation in AR subtype, but not in TD subtype, of early PD patients. These different results between the 2 motor subtypes likely reflects the heterogeneous pathophysiology of PD.
Electroencephalographic evidence of gray matter lesions among multiple sclerosis patients
Authors: Salim Ahmed Abduljawad , Ali Safaa Hussain , Hussain Ansam Munadel , Ibrahim Wisam Nabeel
Published: August 2021

This study aimed to investigate evidence of gray matter brain lesions in multiple sclerosis (MS) patients by evaluating the resting state alpha rhythm of brain electrical activity.

The study included 50 patients diagnosed with MS recruited from the MS clinic with 50 age and gender-matched control participants. The study investigated parameters of posterior dominant rhythm (PDR) in the electroencephalography (EEG) recordings including wave frequency and amplitude. Functional disability among the patients was evaluated according to the expanded disability status scale. Univariate statistical analysis was completed using one-way analysis of variance and t test with a P value of less than .05 to indicate statistical significance.

Patients with MS had significantly lower PDR frequency and amplitude values compared to the controls (P value < .01) and 34% of the MS patients had a PDR frequency of less than 8.5 Hz. The PDR frequency was negatively associated with the level of functional disability among the patients (P value <.001) and 4% of the patients had abnormal epileptiform discharges.

Background slowing of resting alpha rhythms and epileptiform discharges are suggestive of gray matter degeneration and may help in the prediction and follow-up of cortical damage and functional disabilities among MS patients. Therefore, electroencephalography monitoring of the PDR spectrum may serve as an alternative or complementary tool with other imaging techniques to detect and monitor cerebral cortical lesions.
Comparison of clinical efficacy of robotic right colectomy and laparoscopic right colectomy for right colon tumor
Authors: Zhu Quan Li , Xu Xin , Pan Zhi Jian
Published: August 2021

Background:

The purpose of this study was to compare the clinical efficacy of robotic right colectomy (RRC) and laparoscopic right colectomy (LRC) in the treatment of right colon tumor.

Methods:

We systematically searched PubMed, Web of science, EMBASE ClinicalTrials.gov and Cochrane Central Register for studies (studies published between January 2011 and June 2020). The included studies compared the clinical efficacy of RRC and LRC in the treatment of right colon tumor, and analyzed the perioperative data.

Results:

Our meta-analysis included 10 studies involving 1180 patients who underwent 2 surgical procedures, RRC and LRC. This study showed that compared with LRC, there was no significant difference in first flatus passage (weighted mean difference [WMD]: −0.37, 95% CI: −1.09–0.36, P = .32), hospital length of stay (WMD: −0.23, 95% CI: −0.73–0.28, P = .32), reoperation (OR: 1.66, 95% CI: 0.67–4.10, P = .27), complication (OR: 0.83, 95% CI: 0.60–1.14, P = .25), mortality (OR: 0.45, 95% CI: 0.02–11.22, P = .63), wound infection (OR: 0.65, 95% CI: 0.34–1.25, P = .20), and anastomotic leak (OR: 0.73, 95% CI: 0.33–1.63, P = .44). This study showed that compared with LRC, the lymph nodes retrieved (WMD: 1.47, 95% CI: −0.00–2.94, P = .05) of RRC were similar, with slight advantages, and resulted in longer operative time (WMD: 65.20, 95% CI: 53.40–77.01, P < .00001), less estimated blood loss (WMD: −13.43, 95% CI: −20.65–6.21, P = .0003), and less conversion to open surgery (OR: 0.30, 95% CI: 0.17–0.54, P < .0001).

Conclusions:

RRC is equivalent to LRC with respect to first flatus passage, hospital length of stay, reoperation, complication, and results in less conversion to LRC.
Right heart thrombus-in-transit in a patient with Evans syndrome
Authors: Yang Ya-Chen , Chen Yen-Yu
Published: August 2021

Introduction:

Right heart free-floating thrombus in the absence of structural heart disease or atrial fibrillation is rare. When it travels to the heart into the lung, called thrombus-in-transit, may cause cardiopulmonary collapse and sudden death. The clinical presentation varies from mild respiratory symptoms to sudden death; however, there are few clinical case reports of giant, free-floating thrombus in the right heart in an asymptomatic patient, and the optimal management options have not been established.

Patient concerns:

A 36-year-old Asian woman presented to the emergency department with complaints of worsening swelling of the left lower extremity over 12 hours.

Diagnosis:

Left leg deep vein thrombosis accompanied by an asymptomatic giant right atrial thrombus and pulmonary embolism with a rare autoimmune disease of Evans syndrome.

Interventions:

Emergent surgical thrombectomy under cardiopulmonary bypass for right atrial thrombus.

Outcomes:

The postoperative course was uneventful, and she was discharged on the eighth postoperative day with normal heart function and mild tricuspid regurgitation.

Conclusion:

An additional diagnostic workup in cases of deep vein thrombosis is necessary for the rapid diagnosis of right heart thrombus and pulmonary embolism without delay. This case report illustrates that early recognition of venous thromboembolism and emergent thrombectomy of right heart thrombus-in-transit is crucial to prevent mortality.
Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities
Authors: Xu Sui-yi , Wang Ruo-jun , Zhang Lei , Li Chang-xin
Published: August 2021

Rationale:

The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment.

Patient concerns:

A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension.

Diagnoses:

An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94 mm. The length was >182 mm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall.

Interventions:

Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug.

Outcomes:

The patient had no symptoms of neurological damage during 3-month follow-up.

Lessons:

Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10 mm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.
The effect of acute and chronic iodine excess on thyroid profile and reproductive function of women using Lipiodol during hysterosalpingography and the potential impact on thyroid function of their offspring: The SELFI study protocol
Authors: Mathews Divya M. , Peart Jane M. , Sim Robert G. , Johnson Neil P. , O'Sullivan Susannah , Derraik José G.B. , Hofman Paul L.
Published: August 2021

Background:

Hysterosalpingography (HSG) is a radiological procedure using iodinated contrast media to assess tubal patency in women with infertility. HSG using Lipiodol, an oil-soluble contrast medium (OSCM) has been shown to improve pregnancy rates, so its therapeutic use has increased. However, OSCM can cause marked and prolonged iodine excess, potentially impacting thyroid function. If pregnancy occurs, there is also concern regarding possible neonatal hypothyroidism resulting from maternal iodine excess. This study aims to improve knowledge on the safety profile of OSCM HSG in the context of iodine excess.

Methods:

This is a prospective longitudinal study of 200 consecutively consenting women undergoing an OSCM HSG in Auckland, New Zealand. After informed consent, participants will undergo baseline thyroid function tests and measurement of urine iodine-to-creatinine ratio (UI/Cr) and anti-thyroid antibodies. During the HSG, the volume of OSCM used will be recorded, and a delayed radiograph obtained to check for further spill of the contrast and for a semi-quantitative assessment of peritoneal retention of OSCM. Thyroid function tests, UI/Cr and reproductive hormones will be serially monitored over the next 6 months. If the woman conceives within the study period, the offspring's thyroid function will be tested at 7 days of age, in addition to the routine newborn screening. The primary outcome will be development of subclinical hypothyroidism (SCH) in these women. Secondary outcomes will include the incidence of elevated iodine levels in these women, and a transient or permanent thyroid dysfunction in the neonates conceived within the study period. In addition, mixed-model analyses will attempt to identify ‘high-risk’ groups for thyroid dysfunction.

Discussion:

This study will explore the acute and chronic effects of iodine excess on thyroid function in women who undergo an OSCM HSG and in their offspring conceived in the immediate cycles following HSG. Further, this study will provide information on the profile of thyroid function abnormalities following an OSCM HSG, and help guide the establishment of international protocols for thyroid monitoring and management in women undergoing this procedure.

Trial registration:

Trial acronym–SELFI (Safety and Efficacy of Lipiodol in Fertility Investigations)

ACTRN:

ACTRN12620000738921, retrospectively registered on 14/07/2020
Cellular therapies in kidney transplantation
Authors: Leclerc Simon , Lamarche Caroline
Published: August 2021

Purpose of review

Current immunosuppressive regimens used in kidney transplantation are sometimes ineffective and carry significant risks of morbidity and mortality. Cellular therapies are a promising alternative to prolong graft survival while minimizing treatment toxicity. We review the recently published breakthrough studies using cell therapies in kidney transplantation.

Recent findings

The reviewed phase I and II trials showed that cell therapies are feasible and safe in kidney transplantation, sometimes associated with less infectious complications than traditional regimens. Regulatory T cells and macrophages were added to the induction regimen, allowing for lower immunosuppressive drug doses without higher rejection risk. Regulatory T cells are also a treatment for subclinical rejection on the 6 months biopsy. Other strategies, like bone marrow-derived mesenchymal cells, genetically modified regulatory T cells, and chimerism-based tolerance are also really promising. In addition, to improve graft tolerance, cell therapy could be used to prevent or treat viral infection after transplantation.

Emerging data underline that cell therapy is a feasible and safe treatment in kidney transplantation. Although the evidence points to a benefit for transplant recipients, studies with standardized protocols, representative control groups, and longer follow-up are needed to answer the question definitively and guide future research.
Evidence-Based Wound Irrigation: Separating Fact from Fiction
Authors: Saeg Fouad , Schoenbrunner Anna R. , Janis Jeffrey E.
Published: August 2021

The relationship between wound irrigation and healing has been recognized for centuries. However, there is little evidence and no official recommendations from any health care organization regarding best wound irrigation practices. This is the first review of wound irrigation that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence into a practical format. In this comprehensive review, the authors outline the irrigation fluids and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize irrigation effectiveness, and propose evidence-based guidelines to improve wound healing outcomes and enhance the consistency of wound irrigation. Thirty-one high-quality studies with a combined total of 61,808 patients were included. Based on the current evidence provided by this review, the authors propose the following guidelines: (1) acute soft-tissue wounds should receive continuous gravity flow irrigation with polyhexanide; (2) complex wounds should receive continuous negative-pressure wound therapy with instillation with polyhexanide; (3) infected wounds should receive continuous negative-pressure wound therapy with instillation with silver nitrate, polyhexanide, acetic acid, or povidone-iodine; (4) breast implant wounds should receive gravity lavage with povidone-iodine or antibiotics; and (5) surgical-site infection rates can be reduced with intraoperative povidone-iodine irrigation.
A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study
Authors: Kagaya Yu , Arikawa Masaki , Akazawa Satoshi , Miyamoto Shimpei
Published: August 2021

Background:

The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and end-to-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined.

Methods:

Twenty-eight patients who underwent free flap reconstruction after tumor resection were subjected to flow-through arterial anastomosis and flow examination. First, in the end-to-end state, the proximal anastomotic site was measured. This was followed by the opening of the distal arterial clamp, and measurement was then continued (in the flow-through state).

Results:

In flow-through arterial anastomosis compared with end-to-end anastomosis, the volumetric flow rate was significantly increased (18.9 ± 14.1 ml/minute versus 6.0 ± 6.3 ml/minute) and the pulsatility index was significantly decreased (5.2 ± 3.7 versus 13.6 ± 10.2), when comparing paired data. Multiple regression analyses revealed that a perforator flap (versus a musculocutaneous flap) was independently associated with both reduced volumetric flow rate and increased pulsatility index in end-to-end anastomosis, and that hypertension was independently associated with an increased pulsatility index in end-to-end anastomosis. However, no factors in flow-through anastomosis were significantly associated with those values.

Conclusion:

In terms of blood flow and vascular resistance, flow-through arterial anastomosis was considered to have promising quantitative effects and should be performed when the conditions of both the donor and recipient vessels meet the requirements.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation
Authors: Schlegel Andrea , Foley David P. , Savier Eric , Flores Carvalho Mauricio , De Carlis Luciano , Heaton Nigel , Taner C. Burcin
Published: August 2021

Although the utilization of donation after circulatory death donors (DCDs) for liver transplantation (LT) has increased steadily, much controversy remains, and no common acceptance criteria exist with regard to donor and recipient risk factors and prediction models. A consensus conference was organized by International Liver Transplantation Society on January 31, 2020, in Venice, Italy, to review the current clinical practice worldwide regarding DCD-LT and to develop internationally accepted guidelines. The format of the conference was based on the grade system. International experts in this field were allocated to 6 working groups and prepared evidence-based recommendations to answer-specific questions considering the currently available literature. Working group members and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and recommendations provided by working group 2, covering the entire spectrum of donor and recipient risk factors and prediction models in DCD-LT.
A Case of Post-COVID-19–Associated Paracentral Acute Middle Maculopathy and Giant Cell Arteritis-Like Vasculitis
Authors: Jonathan Go L. , Scott Fair M. , Matthew Kay D.
Published: August 2021

A 47-year-old man with a history of COVID-19 infection 2 months before presentation, presented with a scotoma of the paracentral visual field of the right eye. After thorough testing and evaluation, a diagnosis of paracentral acute middle maculopathy (PAMM) was established. Two months later, the patient developed temporal headache and jaw claudication. High-dose steroids were initiated, and workup for giant cell arteritis (GCA) was undertaken. The patient experienced resolution of the symptoms within 24 hours of steroid initiation. ESR, CRP, and temporal artery biopsy results were normal, although all were obtained more than 2 weeks after steroid initiation. To the best of our knowledge, our patient represents the first individual to date to potentially implicate COVID-19 in both small and large vessel vasculitis in the ophthalmic setting.
The relationships between ongoing COVID-19 lockdown and the financial and mental health experiences of Australian families
Authors: Price Anna M. H. , Contreras-Suárez Diana , Zhu Anna , Schreurs Natalie , Measey Mary-Anne , Woolfenden Sue , Burley Jade , Bryson Hannah , Efron Daryl , Rhodes Anthea , Goldfeld Sharon
Published: August 2021

Objectives

In 2020, Australia’s successful COVID-19 public health restrictions comprised a national ‘initial lockdown’ (March-May), and ‘ongoing lockdown’ (July-November) for metropolitan Victorian residents only. We evaluated the relationships between ongoing lockdown and family finances and mental health.

Methods

In the June and September 2020 Royal Children’s Hospital National Child Health Polls, caregivers of children in Victoria and New South Wales reported: job/income loss; material deprivation (inability to pay for essential items); income-poverty; mental health (Kessler-6); perceived impact on caregiver/child mental health; and caregiver/child coping. Data from N=1207/902 caregivers in June/September were analysed using Difference-in-Difference modelling (New South Wales provided the comparator).

Results

During Victoria’s ongoing lockdown, job/income loss increased by 11% (95%CI: 3-18%); Kessler-6 poor mental health by 6% (95%CI: -0.3-12%) and perceived negative mental health impacts by 14% for caregivers (95%CI: 6-23%) and 12% for children (95%CI: 4-20%). Female (versus male) caregivers, metropolitan (versus regional/rural) families, and families with elementary school-aged children (versus pre-/high-school) were most affected.

Conclusions

Ongoing lockdown was associated with negative experiences of mental health, employment, and income, but not deprivation or poverty, likely because of government income supplements introduced early in the pandemic. Future lockdowns require planned responses to outbreaks, and evidence-informed financial and mental health supports.