bluuebunny/crossref_metadata_2025 huggingface dataset:
Optic Nerve Head, Peripapillary and Macular Microvascular Characteristics in Patients With Unilateral Pseudoexfoliation Glaucoma
Authors: Balci Ali Safa , Cakir Ihsan , Altan Cigdem
Published: July 2023

Précis:

In unilateral pseudoexfoliation glaucoma (PEXG), there may be decreased choroidal vascularity index (CVI), radial peripapillary capillary plexus’ perfusion and flow. CVI may also be reduced in fellow eyes, suggesting that PEXG is bilateral disease.

Purpose:

Evaluation of peripapillary and macular choroidal microvascularity and radial peripapillary capillary plexus in both eyes with unilateral PEXG and healthy eyes.

Materials and Methods:

Ninety-six eyes of 48 patients with unilateral PEXG [PEX (+): 48 eyes with PEXG; PEX (−): 48 eyes without PEX] and the right eyes of 45 age- and sex-matched healthy controls were included in the study. CVI was calculated on enhanced depth imaging optical coherence tomography scans. Radial peripapillary capillary vascular layer were evaluated by OCT-angiography.

Results:

Macular CVI (mCVI), temporal and nasal peripapillary CVI (pCVI) was significantly decreased in the PEX (+) compared with the PEX (−) and control group (P<0.05 for all). Although there was a significant difference between PEX (−) and the control group in terms of mCVI and temporal pCVI, there was no significant difference between the 2 groups in terms of nasal pCVI (P=0.008, P=0.036, and P=0.604, respectively). There was a significant difference in perfusion density (PD) and flux index (FI) between PEX (+) group, PEX (−) group and control group in all quadrants and average value (P<0.05 for all). Although the PD and FI values in all quadrants and average values of the PEX (−) group were lower than the control group, this difference was not significant.

Conclusions:

CVI in the macula and peripapillary region was significantly decreased in eyes with PEXG. Similarly, PD and FI were lower in eyes with PEXG. Low mCVI and temporal pCVI can also be seen in eyes without PEX.
Short-Term Outcomes of Bimatoprost Sustained-Release Intracameral Implant in Glaucoma
Authors: Wong Michael K. , Bowers Mallory E. , Ventimiglia Jonas , Niknam Rachel M. , Moster Marlene R. , Pro Michael J. , Dale Elizabeth , Kolomeyer Natasha N. , Lee Daniel , Zheng Cindy X.
Published: July 2023

Précis:

This retrospective study found a statistically significant reduction in mean intraocular pressure (IOP) and the number of medications after intracameral Bimatoprost sustained release (SR) injection in patients with glaucoma. A history of selective laser trabeculoplasty (SLT) did not impact treatment outcomes.

Purpose:

To determine outcomes of Bimatoprost SR on IOP and the number of topical IOP-lowering medications in patients with glaucoma. A secondary objective was to determine the outcomes of Bimatoprost SR in patients with a prior history of SLT.

Methods:

Retrospective case series. One hundred eighteen eyes from 84 patients that received Bimatoprost SR by 6 glaucoma specialists at Wills Eye Hospital from March 2020 to September 2021 were examined. The intervention was a single injection of intracameral Bimatoprost SR. The main outcome measures included IOP and the number of medications.

Results:

The most recent mean follow-up time for all eyes was 27.8 ± 18.6 weeks. The mean posttreatment IOP at the most recent follow-up of 16.6 ± 5.3 mm Hg was significantly lower than the mean under-therapy pretreatment IOP of 18.5 ± 5.7 mm Hg for all eyes (P < 0.01). The mean posttreatment number of medications at the most recent follow-up of 1.3 ± 1.3 decreased compared with the number of pretreatment medications of 2.1 ± 1.4 for all eyes (P < 0.01). Analysis of multilevel models controlling for demographic variables demonstrated a statistically significant reduction in IOP and number of medications posttreatment (P < 0.01). A prior history of SLT (n = 54) had no impact on treatment for both IOP and the number of medications (P > 0.1 for both).

Conclusions:

Intracameral Bimatoprost SR reduced IOP and decreased the number of medications. Prior history of SLT did not impact Bimatoprost SR treatment outcomes.
Identifying Rapid Glaucoma Progression Using Hemifield Rates of Progression
Authors: Leshno Ari , Li Johnny X. , De Moraes Carlos Gustavo , Harizman Noga , Wang Qing , Garg Shukla Aakriti , Cioffi George A. , Liebmann Jeffrey M.
Published: July 2023

Précis:

Hemifield rates of progression are more sensitive to focal progression (or faster progression) than global rates. This can aid in tailoring management and treatment decisions.

Purpose:

To determine if the rate of progression (ROP) of each hemifield of the 24-2 visual field (VF) aids in the detection of rapidly progressing eyes.

Methods:

In this retrospective longitudinal study, we evaluated 1658 eyes of 1658 consecutive glaucoma patients with global mean deviation (MD) VF loss between −3 and −15 dB at baseline and ≥8 reliable VF tests (Swedish Interactive Thresholding Algorithm 24-2) with over ≥3 years of follow-up. The ROP (dB/year) based on global MD, superior hemifield MD, and inferior hemifield MD was calculated. The worst hemifield ROP (ROPworst) and hemifield ROP absolute difference (ROPdiff) were determined for each eye. Eyes were categorized based on the ROP from each metric as slow (−0.5 dB/year or better), rapid (worse than −0.5 dB/year), very rapid (worse than −1.0 dB/year), and catastrophic (worse than −2.0 dB/year) progression. The rate of significant asymmetric hemifield progression rate (ROPdiff ≥0.5 dB/year) was also evaluated.

Results:

On average, ROPworst was faster than ROPglobal by 0.25±0.3 dB/year (P<0.001). Based on ROPworst, 422 eyes (25%) were classified as progressing more rapidly than the ROPglobal classification. Over 40% (153/339) of the eyes classified as rapid progressors by ROPglobal were classified as very rapid or catastrophic progressors based on ROPworst. Eyes that progressed more rapidly based on ROPworst also had a higher rate of asymmetric progression.

Conclusion:

Hemifield ROPs are more sensitive to focal progression (or faster progression) than global rates and can aid in tailoring management and treatment decisions.
Staphylococcus aureus Bacteremia in the Pediatric Emergency Department and Predictors of Poor Outcome
Authors: Suárez-Bustamante Huélamo María , Alonso-Cadenas José Antonio , Cortés Borja Gómez , Goikoetxea Iker Gangoiti , Hernández-Bou Susanna , de la Torre Espí Mercedes ,   on behalf of Bacteremia Study Working Group from the Infectious Diseases Working Group, Spanish Society of Pediatric Emergencies
Published: July 2023

Background:

Staphylococcus aureus has become the leading cause of bacteremia among previously healthy children older than 5 years.

Methods:

We aimed to describe the infants presenting to pediatric emergency departments and diagnosed with S. aureus bacteremia (SAB) and identify predictors (clinical and laboratory variables) of poor outcome (complications, sequelae or death). We performed an observational study and subanalysis of a multicenter prospective registry, including every patient under the age of 18 years with a positive blood culture obtained at any of the 22 participating Spanish pediatric emergency departments between 2011 and 2016. We considered chronic diseases, immunosuppressive treatment and the presence of mechanical devices as risk factors for SAB.

Results:

Of the 229 patients with SAB, 176 (76.9%) were previously healthy, 192 (83.8%) had a normal pediatric assessment triangle and 158 (69.0%) had an associated focal infection (mainly osteoarticular infection, skin and soft tissue infection and pneumonia). Fifty-three patients (23.1%) had 1 or more risk factors for SAB. Thirty-one (13.5%) presented a poor outcome, including 4 deaths (1.7%). A poor outcome was more common in patients with SAB risk factors [odds ratio (OR): 7.0; 95% CI: 3.2–15.4], abnormal PAT (OR: 5.9; 95% CI: 2.6–13.3), elevated procalcitonin (OR: 1.2; 95% CI: 1.05–1.3) and C-reactive protein, the latter being the only independent predictor of poor outcome (OR: 1.01; 95% CI: 1.01–1.02).

Conclusions:

Overall, children with SAB are previously healthy, appear well, and have an associated focal infection. One of 7 had a poor outcome, with C-reactive protein being the only predictor identified.
Relationship Between Real-time TDM-guided Pharmacodynamic Target Attainment of Continuous Infusion Beta-lactam Monotherapy and Microbiologic Outcome in the Treatment of Critically Ill Children With Severe Documented Gram-negative Infections
Authors: Gatti Milo , Campoli Caterina , Latrofa Maria Elena , Ramirez Stefania , Sasso Tommaso , Mancini Rita , Caramelli Fabio , Viale Pierluigi , Pea Federico
Published: July 2023

Objectives:

To explore the relationship between real-time therapeutic drug monitoring (TDM)-guided pharmacodynamic target attainment of continuous infusion (CI) beta-lactam monotherapy and microbiological outcome in the treatment of critically ill children with severe documented Gram-negative infections.

Methods:

Observational, monocentric, retrospective study of critically ill patients receiving CI piperacillin-tazobactam, ceftazidime, or meropenem in monotherapy for documented Gram-negative infections optimized by means of a real-time TDM-guided strategy. Average steady-state beta-lactam concentrations (Css) were calculated for each patient, and the beta-lactam Css/minimum inhibitory concentration (MIC) ratio was selected as a pharmacodynamic parameter of efficacy. The Css/MIC ratio was defined as optimal if ≥4, quasi-optimal if between 1 and 4, and suboptimal if <1. The relationship between Css/MIC and microbiological outcome was assessed.

Results:

Forty-six TDM assessments were carried out in 21 patients [median age 2 (interquartile range: 1–8) years]. Css/MIC ratios were optimal in 76.2% of cases. Patients with optimal Css/MIC ratios had both a significantly higher microbiological eradication rate (75.0% vs. 0.0%; P = 0.006) and lower resistance development rate (25.0% vs. 80.0%; P = 0.047) than those with quasi-optimal or suboptimal Css/MIC ratios. Quasi-optimal/suboptimal Css/MIC ratio occurred more frequently when patients had infections caused by pathogens with MIC values above the European Committee on Antimicrobial Susceptibility Testing clinical breakpoint (100.0% vs. 6.3%; P < 0.001).

Conclusions:

Real-time TDM-guided pharmacodynamic target attainment of CI beta-lactam monotherapy allowed to maximize treatment efficacy in most critically ill children with severe Gram-negative infections. Attaining early optimal Css/MIC ratios of CI beta-lactams could be a key determinant associated with microbiologic eradication during the treatment of Gram-negative infections. Larger prospective studies are warranted for confirming our findings.
Epidemiology and Clinical Features of Human Metapneumovirus and Respiratory Syncytial Viral Infections in Children
Authors: Nadiger Meghana , Sendi Prithvi , Martinez Paul A. , Totapally Balagangadhar R.
Published: July 2023

Background:

Human metapneumovirus (HMPV) and respiratory syncytial virus (RSV) are 2 common causes of acute respiratory tract infections in infants and young children. The objective of this study is to compare the demographics and outcomes of children hospitalized with HMPV and RSV infections in the United States.

Methods:

We performed a retrospective cohort analysis of children 1 month to less than 3 years old discharged during 2016 with HMPV or RSV infection using the Kids’ Inpatient Database. Children with HMPV and RSV coinfection were excluded. Data were weighted for national estimates.

Results:

There were 6585 children with HMPV infection and 70,824 with RSV infection discharged during the study period. The mean age of children with HMPV infection was higher than that of children with RSV infection (0.73 ± 0.8 vs. 0.42 ± 0.7 years; P < 0.05). The mortality rate was significantly higher in children with the presence of any complex chronic conditions compared to those without, in both HMPV [odds ratio (OR): 32.42; CI: 9.931–105.857; P < 0.05] as well as RSV (OR: 35.81; CI: 21.12–57.97; P < 0.05) groups. The adjusted median length of stay was longer (4.64 days; CI: 4.52–4.76 days vs. 3.33 days; CI: 3.31–3.35 days; P < 0.001) and total charges were higher ($44,358; CI: $42,145–$46,570 vs. $22,839; CI: $22,512–$23,166; P < 0.001), with HMPV infection. The mortality rate was similar in HMPV infection compared to RSV infection on multivariable analysis (OR: 1.48; P > 0.05).

Conclusion:

In hospitalized children in the United States, HMPV infection is less common than RSV infection. Complex chronic conditions are more prevalent in children hospitalized with HMPV infection. Hospitalization with HMPV is associated with longer length of stay and higher hospital charges. The adjusted mortality is similar with both infections.
Antimicrobial Resistance Patterns Among Neonates Referred to Pediatric Emergency in North India: A Prospective Cohort Study
Authors: Kumar Jogender , Soni Prakash Kumar , Angrup Archana , Saini Shiv Sajan , Sundaram Venkataseshan , Mukhopadhyay Kanya , Dutta Sourabh , Kumar Praveen
Published: July 2023

Background:

Sepsis is a leading cause of neonatal mortality worldwide, with a disproportionately high burden in low-income and middle-income countries. There is limited prospective data on microorganism profiles and antimicrobial resistance (AMR) in outborn newborns referred to pediatric emergency in developing countries. We aimed to assess the pathogen profile and AMR patterns in outborn neonates referred to the pediatric emergency at a tertiary care center.

Methods:

In this prospective cohort study, we enrolled neonates with suspected sepsis and sent blood or cerebrospinal fluid cultures. Neonates were followed up daily until discharge or death. The isolated organisms were identified and tested for antimicrobial susceptibility. Standard definitions were used to define multidrug resistance.

Results:

Between January 1, 2020, and December 31, 2020, 1072 outborn neonates with suspected sepsis were enrolled. The rate of proven sepsis was 223.6 (95% CI:198.7–248.4) per 1000 infants. Gram-negative sepsis was the most common (n = 107,10%), followed by gram-positive sepsis (n = 81,7.6%) and fungal sepsis (n = 67,6.3%). Coagulase-negative staphylococci (n = 69), Candida spp. (n = 68), Klebsiella spp. (n = 55), Acinetobacter spp. (n = 31) and Escherichia coli (n = 9) were the most common pathogens. Over two-thirds (68.6%) of pathogens were multidrug resistance, with an alarming prevalence in Klebsiella spp. (33/53, 62%), Acinetobacter spp. (25/30, 83%) and coagulase-negative staphylococci (54/66, 82%). In total, 124 (11.6%) neonates died in the hospital (13.3% of proven cases and 11.1% of culture-negative sepsis cases).

Conclusions:

High sepsis burden and alarming AMR among neonates referred to tertiary care centers warrant urgent attention toward coordinated implementation of rigorous sepsis prevention measures and antimicrobial stewardship across all healthcare levels.
Fulminant Myocarditis Associated With Parvovirus B19 and Epstein-Barr Virus Coinfection
Authors: Yan Crystal Lihong , Gupta Gaurav , Guido Luiz Paulo , Ruiz Philip , Grazette Luanda , Bauerlein E. Joseph , Rivera Nina Thakkar
Published: July 2023

Parvovirus B19 (PVB19) and Epstein-Barr virus (EBV) commonly cause infection worldwide, with most persons infected during childhood. Their disease courses are usually mild and brief; however, PVB19 and EBV have been implicated as etiologies of viral myocarditis. We report a case of PVB19 and EBV coinfection associated with fulminant lymphocytic myocarditis. We address the implications of the case, including the differential diagnosis, immunomodulatory treatment considerations, and evidence for the pathologic roles of PVB19, EBV, and coinfection in myocarditis. Although the pathogenic roles of PVB19 or EBV alone in myocarditis are not well established, coinfection of PVB19 and EBV may unlock their pathogenic roles causing fulminant myocarditis. Treatment with steroids and intravenous immunoglobulin G in a patient with rapid clinical deterioration despite the presence of active infection on endomyocardial biopsy by polymerase chain reaction can result in a safe and quick recovery of fulminant viral myocarditis. Early and aggressive intervention, including both mechanical circulatory support and immunomodulatory therapy, may be key to improved outcomes in cases of fulminant myocarditis.
Endotherapy in pediatric pancreatitis
Authors: Norris Nicholas , Troendle David M.
Published: July 2023

Purpose of review

Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research.

Recent findings

Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection.

Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.
Endoluminal bariatric and metabolic therapies: state-of-the-art
Authors: Bakheet Nader , Badurdeen Dilhana , Sartoretto Adrian , Kumbhari Vivek
Published: July 2023

Purpose of review

The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of these endoluminal bariatric and metabolic procedures.

Recent findings

The landscape of endoluminal devices and techniques for treating obesity has expanded significantly, with FDA-approved therapies currently available to patients with a body mass index values as high as 50 kg/m2. Although notable advancements have been made in this area, there is a need for further emphasis to be placed on the metabolic improvements resulting from these therapies, in addition to the conventional focus on weight loss outcomes. Some of these procedures are now FDA approved for the treatment of metabolic disease as opposed to weight loss. To achieve the most favorable results, it is imperative that all endoluminal interventions are combined with a moderately intensive diet and lifestyle program lasting at least 12 months.

Endoluminal metabolic and bariatric therapy represents a bridge between lifestyle counseling, pharmaceutical interventions, and the most efficacious treatment for obesity, bariatric surgery. By virtue of its minimally invasive approach, this therapy may be an appealing option for patients who are ineligible for, or averse to, bariatric surgery and who have experienced suboptimal outcomes or unable to afford medical treatments. Furthermore, these interventions may be particularly beneficial in the early stages of obesity.
Tissue factor positive microparticles as a biomarker for increased risk of breast cancer-associated thrombosis: a mini review
Authors: Bucciol Regan , Othman Maha
Published: July 2023

Purpose of review

Cancer-associated thrombosis (CAT), such as venous thromboembolism (VTE), is a frequent complication in cancer patients, resulting in poor prognosis. Breast cancer is not highly thrombogenic but is highly prevalent, resulting in increased VTE cases. Many cancers express tissue factor (TF), a glycoprotein that triggers coagulation. The cancer cells were shown to express and release substantial amounts of TF-positive microparticles (MPTF), associated with a prothrombotic state. This narrative review evaluated the current use of the procoagulant MPTF as a biomarker for thrombosis risk in breast cancer.

Recent findings

Tumors of epithelial origin with elevated TF expression have been associated with increased VTE incidence. Thus, studies have affirmed the use of MPTF biomarkers for VTE risk in many cancers. Patients with metastatic breast cancer and CAT were found to exhibit elevated procoagulant microparticles in vitro, due to TF expression. The silencing of TF was associated with decreased microparticle release in breast carcinoma cell lines, associated with decreased coagulation.

CAT is a multifactorial condition, with several various underlying diseases. It is proposed that MPTF may be an effective biomarker for thrombosis risk in breast cancer patients but requires a more systemic evaluation utilizing standardized quantification methods.
Switching and increasing prophylaxis regimen with a genetically recombinant fusion of coagulation factor IX and albumin in haemophilia B: a case report
Authors: Álvarez-Román María Teresa , Merchán Raquel Díaz , Mellado Roberto Carlos Raynero , Jiménez-Yuste Victor
Published: July 2023

Purpose of review

We present a case of a boy diagnosed in 2007 with severe haemophilia B [factor IX (FIX) concentration < 1%] at age of 9 months. He was initially treated with recombinant FIX concentrates, but changes in regimens were frequent due to spontaneous hemarthros. In 2013, he entered a phase III trial (NCT01662531) and received rIX-FP, IDELVION at 50 IU/kg once a week. Although the boy was safely maintained with this regimen (2015–2017), the number of hemarthros increased after he started to play football. Thus, rIX-FP regimen was modified (40 IU/kg twice/week) to optimize therapy. This modification was efficient on maintaining patient's thought levels (33%), helped during his fully incorporation at school and social life, and significantly improved synovial hypertrophy. In the last year, the boy has not suffered any bleeding episode and his joint situation improved significantly, which allowed reducing doses to weekly recommended doses.

Recent findings

FIX replacement therapies with intravenous plasma-derived FIX (pdFIX) or standard half-life recombinant FIX (rFIX) concentrates are hampered by the relatively short terminal elimination half-life (t
1/2) of these substances (around 17–34 h), resulting in the need for frequent infusions (e.g. once every 3 or 4 days) to maintain protective FIX levels. In the past years, the first genetically recombinant fusion of rFIX with another protein - a recombinant human albumin – was developed (albutrepenonacog-alfa or rIX-FP; IDELVION) as a strategy to extend the t
1/2 of rFIX-FP (around 95 h).

We provide information about the difficult management of a patient with a major bleeding haemorrhagic phenotype, which caused serious limitations in the patient's daily life, impacting his quality of life at his young age, and how the switch to IDELVION allowed the situation to improve considerably.
A Ruptured Mucinous Cystadenocarcinoma of the Pancreas Extensively Evaluated Before and After the Rupture
Authors: Oyama Keisuke , Iwagami Yoshifumi , Kobayashi Shogo , Sasaki Kazuki , Yamada Daisaku , Tomimaru Yoshito , Akita Hirofumi , Noda Takehiro , Asaoka Tadafumi , Nakahira Shin , Gotoh Kunihito , Takahashi Hidenori , Tanemura Masahiro , Doki Yuichiro , Eguchi Hidetoshi
Published: July 2023

Pancreatic mucinous cystic neoplasm (MCN) rarely ruptures because of their surrounding fibrotic capsules and has never been reported with detailed information regarding prerupture and postrupture states. We report a case of MCN rupture where performed emergency surgery was performed while waiting for elective surgery. A 54-year-old woman was referred to our department for a pancreatic cystic tumor with slight abdominal pain. A cystic tumor with a nodular lesion was found, with a contrast effect measuring 78 mm in diameter. On day 21, the patient visited our hospital complaining of increased abdominal pain, but few signs of peritonitis were observed. Tests conducted revealed moderate ascites, marginal shrinkage of the cyst diameter, and a slight elevation of inflammatory markers. We suspected an MCN rupture and immediately performed distal pancreatectomy. Brown turbid ascites and rupture of the anterior wall of the cyst were observed. In the ascites, amylase levels were not elevated, and bacterial cultures were negative. The histopathological diagnosis was noninvasive mucinous cystadenocarcinoma. At 9 months after surgery, she started chemotherapy because of a recurrence of the peritoneal dissemination. This case provided valuable insight into the rupture of MCNs using thorough imaging techniques, laboratory, and physical findings before and after rupturing.
Endoscopic Ultrasound Guided Shear Wave Elastography Is Safe With High Feasibility and Reproducibility When Used in the Pancreas
Authors: Abboud Yazan , Kim Katherine , Samaan Jamil S. , Chen Clara , Lew Daniel , Ghaith Jenan , Caldera Wendy , El Helou Mohamad Othman , Park Kenneth H. , Liu Quin , Gupta Kapil , Watson Rabindra , Lo Simon K. , Pandol Stephen J. , Gaddam Srinivas
Published: July 2023

Objectives

The aim of this study was to assess the safety, feasibility, and reproducibility of endoscopic ultrasound shear wave elastography (EUS-SWE) in the pancreas.

Methods

This is a prospective registry of consecutive patients undergoing clinically indicated EUS. Ten readings of SWE velocities (Vs [distance/time, m/s]) were obtained in the head (HOP), body, and tail of pancreas to quantify tissue stiffness. Each Vs score was accompanied by a reliability measurement VsN (%) with VsN >50% considered reliable. Safety was evaluated by perioperative complications rate. Feasibility was determined by technical success of obtaining measurements. Reproducibility was evaluated using intraclass correlation coefficient analysis.

Results

Total of 3320 EUS-SWE measurements were performed on 117 patients without perioperative complications. Measurement success rate was 100% across all locations. Reliable measurements were more common in the HOP (953/1120 [85.1%]) followed by body (853/1130 [75.5%]) and tail of pancreas (687/1070 [64.2%]) (P < 0.001). The analysis showed good reproducibility in all locations (intraclass correlation coefficient range, 0.80–0.89).

Conclusions

Endoscopic ultrasound-SWE is safe, has 100% technical success rate, and is highly reproducible when used in the pancreas. Our study suggests that SWE measurements in the HOP offer the highest reliability, likely because of large study area and less respiratory artifact.
Pediatric Autoimmune Pancreatitis
Authors: Becker Erica C. , Kumar Rakesh , Altaf Adnan , Yu Zhongxin , Lawrence Tony , Palle Sirish
Published: July 2023

Objectives

Autoimmune pancreatitis (AIP) is a rare form of a chronic, immune-mediated, inflammatory pancreatic condition. There is limited data regarding presentation and outcome in the pediatric population. We described a single-center case series of 4 pediatric patients with AIP to better understand the presentation, symptoms, and outcomes of this rare condition.

Methods

Data collected included demographics, serology markers, symptoms at presentation, imaging, additional organ involvement, histology, treatment methods, and outcomes. The diagnosis of AIP was made by a combination of serology, pancreatic imaging, histology, extrapancreatic manifestations, and steroid response.

Results

All patients were diagnosed with type 2 AIP. Abdominal pain, emesis, and obstructive jaundice were the most common symptoms at presentation. Autoimmune markers were negative. Cross-sectional abdominal imaging showed diffuse/focal pancreatic gland enlargement and common bile duct stricture universally and main pancreatic duct irregularity in half of the patients. Biopsies showed lymphoplasmacytic infiltration with associated pancreatic fibrosis and atrophy. Treatment with an 8-week tapering course of prednisone showed prompt response with resolution of symptoms and normalization of laboratory test results.

Conclusions

Our case series shows that AIP in children is a rare entity with a distinct clinical presentation, classical radiographic and histological features with good long-term prognosis.
Effect of Aggressive Intravenous Fluid Resuscitation Versus Nonaggressive Fluid Resuscitation in the Treatment of Acute Pancreatitis
Authors: Ding Xiaowen , Chen Bo
Published: July 2023

Objectives

Despite the need for active fluid therapy, fluid management of most acute pancreatitis (AP) cases is still supportive. The aim of this review is to compare the effect of aggressive versus nonaggressive intravenous (IV) fluid resuscitation in the treatment of acute pancreatitis.

Methods

A systematic search of medical databases, such as Medline, Google Scholar, Science Direct, Cochrane Central, was conducted for publication until April 2022. We included randomized controlled trials or cohort (prospective and retrospective) studies reporting the outcomes of AP in patients that were managed with aggressive and nonaggressive IV fluid resuscitation. The primary outcome of interest was in-hospital mortality.

Results

Fourteen trials involving 3423 acute pancreatitis patients were included in the review. We did not observe any differences in the risk of mortality, persistent organ failure, and systemic inflammatory response syndrome in both study groups. However, there was an increased risk of development of pancreatic necrosis, renal failure, and respiratory failure in the aggressive fluid therapy group compared with nonaggressive therapy. The funnel plot showed no publication bias

Conclusions

Aggressive fluid therapy did not improve mortality rates in acute AP patients and was associated with an increased risk of acute renal failure, and respiratory failure.
Is Delaying a Coloanal Anastomosis the Ideal Solution for Rectal Surgery
Authors: Collard Maxime K. , Rullier Eric , Tuech Jean-Jacques , Sabbagh Charles , Souadka Amine , Loriau Jérome , Faucheron Jean-Luc , Benoist Stéphane , Dubois Anne , Dumont Frédéric , Germain Adeline , Manceau Gilles , Marchal Frédéric , Sourrouille Isabelle , Lakkis Zaher , Lelong Bernard , Derieux Simon , Piessen Guillaume , Laforest Anaïs , Venara Aurélien , Prudhomme Michel , Brigand Cécile , Duchalais Emilie , Ouaissi Mehdi , Lebreton Gil , Rouanet Philippe , Mège Diane , Pautrat Karine , Reynolds Ian S. , Pocard Marc , Parc Yann , Denost Quentin , Lefevre Jérémie H. ,   for the GRECCAR Group
Published: July 2023

Objectives:

To assess the specific results of delayed coloanal anastomosis (DCAA) in light of its two main indications.

Summary Background Data:

DCAA can be proposed either immediately after a low anterior resection (primary-DCAA) or after failure of a primary pelvic surgery as a salvage procedure (salvage-DCAA).

Methods:

All patients who underwent DCAA intervention at 30 GRECCAR-affiliated hospitals between 2010 and 2021 were retrospectively included.

Results:

564 patients (male: 63%; median age: 62 years IQR[53-69]) underwent a DCAA: 66% for primary-DCAA and 34% for salvage-DCAA. Overall morbidity, major morbidity and mortality were 57%, 30% and 1.1%, without any significant differences between primary-DCAA and salvage-DCAA (P=0.933;P=0.238 andP=0.410 respectively). Anastomotic leakage was more frequent after salvage-DCAA (23%) than after primary-DCAA (15%), (P=0.016).

Fifty-five patients (10%) developed necrosis of intra-abdominal colon. In multivariate analysis, intra-abdominal colon necrosis was significantly associated with male sex (OR=2.67 95%CI[1.22-6.49];P=0.020), BMI>25 (OR=2.78 95%CI[1.37-6.00];P=0.006) and peripheral artery disease (OR=4.68 95%CI[1.12-19.1];P=0.030). The occurrence of this complication was similar between primary-DCAA (11%) and salvage-DCAA (8%), (P=0.289).

Preservation of bowel continuity was reached 3 years after DCAA in 74% of the cohort (primary-DCAA:77% vs. salvage-DCAA: 68%,P=0.031). Among patients with a DCAA fashioned without diverting stoma, 75% (301/403) have never required a stoma at the last follow-up.

Conclusions:

DCAA makes it possible to definitively avoid a stoma in 75% of patients when fashioned initially without stoma and to save bowel continuity in 68% of the patients in the setting of failure of primary pelvic surgery.
Keyhole Versus Sugarbaker Mesh Configuration in Parastomal Hernia Repair: A Systematic Review and Meta-analysis
Authors: Mazzola Poli de Figueiredo Sergio , Rodrigues Amanda Cyntia Lima Fonseca , de Araújo Sérgio Walmir , Mao Rui-Min Diana , Villasante-Tezanos Alejandro , Tastaldi Luciano , Lu Richard
Published: July 2023

Background:

Parastomal hernia repairs (PHRs) are often complex and challenging, even for experienced abdominal wall surgeons. Although the ideal therapeutic option in the setting of a parastomal hernia is to restore intestinal continuity, this is often not feasible, and numerous techniques have been described for PHR. Current guidelines recommend using mesh for elective PHR, but there is a scarcity of evidence comparing different PHR techniques. We aimed to report a meta-analysis comparing the outcomes of the “Sugarbaker” and “Keyhole” mesh configuration in PHR.

Methods:

A literature search of PubMed, Embase, Scopus, and Cochrane Library databases was performed to identify studies comparing Sugarbaker and Keyhole mesh configuration in PHR. Postoperative outcomes were assessed by means of pooled analysis and meta-analysis. Statistical analysis was performed using RevMan 5.4. Heterogeneity was assessed with I
2 statistics.

Results:

A total of 3247 studies were screened, and 27 were fully reviewed. Ten studies and 632 patients were included in the meta-analysis. Three hundred five patients (48.3%) with Keyhole and 327 patients (51.7%) with Sugarbaker mesh configuration. Four hundred thirty-three patients (68.5%) underwent laparoscopic PHR with intraperitoneal onlay mesh. Sugarbaker mesh configuration was associated with lower hernia recurrence compared with Keyhole (odds ratio: 0.39; 95% CI: 0.19-0.83; P = 0.01; I
2 = 46%). No differences were seen in overall complications, reoperations, stoma outlet obstruction, mesh infection, and postoperative bleeding.

Conclusion:

PHR with Sugarbaker mesh configuration is associated with decreased hernia recurrence compared with Keyhole and had similar rates of overall complications, reoperations, stoma outlet obstruction, mesh infection, and postoperative bleeding.
Intracorporeal Anastomosis and ERAS Program: The Winning Combination of Optimized Postoperative Outcomes After Laparoscopic Right Colectomy
Authors: Meillat Hélène , Du Castel Héloise , Aubert Mathilde , Brun Clément , de Chaisemartin Cécile , Faucher Marion , Lelong Bernard
Published: July 2023

Background:

Laparoscopic technique and the enhanced recovery after surgery (ERAS) protocol have become the standard of care in patients undergoing right colon cancer surgery, reducing hospital stay and postoperative morbidity. However, the optimal anastomosis technique [intracorporeal anastomosis (ICA) or extracorporeal anastomosis (ECA)] remains debated. This study aimed to determine the optimal perioperative approach (ICA vs. ECA combined with the ERAS program vs. standard care) for patients undergoing laparoscopic right colectomy for cancer.

Materials and Methods:

This single-center, retrospective study evaluated all consecutive patients who underwent laparoscopic right hemicolectomy for cancer between January 2012 and June 2021. Patient data were analyzed in 4 treatment groups according to the type of anastomosis and the care protocol. The primary endpoint was total postoperative hospital stay (THS). The secondary endpoints were recovery time and overall morbidity rate.

Results:

The baseline characteristics of the 373 included patients were comparable between the 4 groups. THS was significantly shorter in the ICA/ERAS group than in the ECA/standard and ICA/standard groups (P<0.01), but there was no significant difference between the ICA/ERAS and ECA/ERAS groups (5.7 vs. 6.4 d; P=0.17). Recovery time was significantly shorter in the ICA/ERAS group (P<0.01). The overall morbidity rate, including anastomotic morbidity, was comparable among the 4 groups. Regression analysis showed that ICA and the ERAS program were both predictive factors to reduce the THS and recovery time.

Conclusions:

ICA combined with the ERAS program achieves the best outcomes and thus seems to be the optimal approach for the management of patients undergoing laparoscopic right colectomy for cancer.
Transvaginal Natural Orifice Specimen Extraction (NOSE) in Laparoscopic Colorectal Cancer Surgery With New Insights on Technique and Patient Selection
Authors: Seow-En Isaac , Khor Shao Nan , Koo Chee Hoe , Wee Ian Jun Yan , Tan Emile Kwong-Wei
Published: July 2023

Background:

Following laparoscopic colorectal surgery, transabdominal specimen extraction requires a mini-laparotomy or Pfannenstiel incision, associated with increased postoperative pain and wound complications. The vagina has several unique properties that make natural orifice specimen extraction (NOSE) ideal. We report our experience with transvaginal NOSE for colorectal cancer surgery.

Materials and Methods:

A transvaginal sizer allows the posterior vagina to be incised under tension. A transverse or cruciate incision is made, followed by the insertion of a double-ring wound protector. The external ring is opened against the perineum to shorten the length of the conduit for specimen delivery. Vaginotomy closure is performed via laparoscopy using a barbed suture.

Results:

Seventeen consecutive female patients underwent elective colorectal cancer surgery with attempted transvaginal NOSE. Median age and body mass index was 67 (range: 50 to 82) years and 26.5 (range: 19.7 to 35.8) kg/m2, respectively. Fourteen patients (82%) underwent left-sided resections and 3 (18%) underwent right-sided resections. Median operating time, blood loss, and length of hospital stay was 245 (range: 155 to 360) minutes, 30 (range: 10 to 500) mL, and 3 (range: 2 to 9) days, respectively. Transvaginal extraction was unsuccessful in 1 (6%) patient. Two (12%) patients experienced early postoperative morbidity, neither attributable to the extraction procedure. Median tumor circumferential diameter was 3.3 (range: 2.2 to 7.0) cm. Median follow-up duration was 17 (range: 8 to 27) months. There was no instance of sexual dysfunction.

Conclusions:

Transvaginal NOSE for colorectal cancer surgery is feasible and safe in selected patients. Overall specimen diameter, inclusive of tumor and mesentery, relative to pelvic outlet and conduit diameter is the most important consideration for transvaginal NOSE.
Balloon-occluded Esophageal Varices Obliteration Versus Ligation for the Management of F2 Esophageal Varices: A Randomized Controlled Trial
Authors: Mei Xuecan , Zhang Qianqian , Zhang Fuming , Jin Jing , Zeng Zhuang , Kong Derun
Published: July 2023

Aim:

To compare balloon-occluded esophageal varices obliteration (BEVO) with esophageal variceal ligation (EVL) in the management of cirrhotic patients with type F2 esophageal varices (F2-EVs).

Materials and methods:

A total of 157 patients with F2-EVs were randomly assigned to either BEVO (n=79) or EVL (n=78) group in the prospective study between July 2021 and December 2021. Primary outcomes included recurrence and eradication rates. Secondary outcomes included rebleeding rate, and procedural complications.

Results:

The recurrence rate of EVs was notably lower in the BEVO group than in the EVL group (3.80% vs. 21.79%; P=0.001). The rate of complete eradication in the BEVO group was significantly higher than that of the EVL group (96.20% vs. 74.36%; P<0.001). The incidence of rebleeding in the BEVO group was markedly lower than that of the EVL group (7.59% vs. 20.51%; P=0.02). There was a higher incidence of transient dysphagia in the EVL group than in the BEVO group (10.26% vs. 1.27%; P=0.015).

Conclusions:

BEVO exerted an effective treatment option for F2-EVs.
Genomic diversity and epidemiological significance of non-typhoidal Salmonella found in retail food collected in Norfolk, UK
Authors: Bloomfield Samuel J. , Janecko Nicol , Palau Raphaёlle , Alikhan Nabil-Fareed , Mather Alison E.
Published: July 2023

Non-typhoidal

Salmonella

(NTS) is a major cause of bacterial gastroenteritis. Although many countries have implemented whole genome sequencing (WGS) of NTS, there is limited knowledge on NTS diversity on food and its contribution to human disease. In this study, the aim was to characterise the NTS genomes from retail foods in a particular region of the UK and assess the contribution to human NTS infections. Raw food samples were collected at retail in a repeated cross-sectional design in Norfolk, UK, including chicken (n=311), leafy green (n=311), pork (n=311), prawn (n=279) and salmon (n=157) samples. Up to eight presumptive NTS isolates per positive sample underwent WGS and were compared to publicly available NTS genomes from UK human cases. NTS was isolated from chicken (9.6 %), prawn (2.9 %) and pork (1.3 %) samples and included 14 serovars, of which

Salmonella

Infantis and

Salmonella

Enteritidis were the most common. The S. Enteritidis isolates were only isolated from imported chicken. No antimicrobial resistance determinants were found in prawn isolates, whilst 5.1 % of chicken and 0.64 % of pork samples contained multi-drug resistant NTS. The maximum number of pairwise core non-recombinant single nucleotide polymorphisms (SNPs) amongst isolates from the same sample was used to measure diversity and most samples had a median of two SNPs (range: 0–251). NTS isolates that were within five SNPs to clinical UK isolates belonged to specific serovars: S. Enteritidis and S. Infantis (chicken), and S. I 4,[5],12:i- (pork and chicken). Most NTS isolates that were closely related to human-derived isolates were obtained from imported chicken, but further epidemiological data are required to assess definitively the probable source of the human cases. Continued WGS surveillance of

Salmonella

on retail food involving multiple isolates from each sample is necessary to capture the diversity of

Salmonella

and determine the relative importance of different sources of human disease.
Artificial Intelligence Helps to Predict Recurrence and Mortality for Prostate Cancer Using Histology Images
Authors: Eminaga Okyaz , Saad Fred , Tian Zhe , Wolffgang Ulrich , Karakiewicz Pierre I. , Ouellet Véronique , Azzi Feryel , Spieker Tilmann , Helmke Burkhard M. , Graefen Markus , Jiang Xiaoyi , Xing Lei , Witt Jorn H. , Trudel Dominique , Leyh-Bannurah Sami-Ramzi
Published: July 2023

Besides grading, deep learning could improve expert consensus to predict prostate cancer (PCa) recurrence. We developed a novel PCa recurrence prediction system based on artificial intelligence (AI). We validated it using multi-institutional and international datasets comprising 2,647 PCa patients with at least a 10-year follow-up. Survival analyses were performed and goodness-of-fit of multivariate models was evaluated using partial likelihood ratio tests, Akaike’s test, or Bayesian information criteria to determine the superiority of our system over existing grading systems. Comprehensive survival analyses demonstrated the effectiveness of our AI- system in categorizing PCa into four distinct risk groups. The system was independent and superior to the existing five grade groups for malignancies. A high consensus level was observed among five blinded genitourinary pathology experts in ranking images according to our prediction system. Therefore, AI may help develop an accurate and clinically interpretable PCa recurrence prediction system, facilitating informed decision-making for PCa patients.
A new paradigm of intracrine free fatty acid receptor 4 signaling at lipid droplets
Authors: Tripp Emma , O’Brien Shannon L. , Smith Gabrielle , Boufersaoui Adam , Roberts Jennie , Pike Jeremy , Correia Joao , Miljus Tamara , Tennant Daniel A. , Hudson Brian D. , Milligan Graeme , Gerhart-Hines Zachary , Schwartz Thue W. , Calebiro Davide
Published: July 2023

G protein-coupled receptors (GPCRs), once thought to be active exclusively at the plasma membrane, have been shown to signal from multiple intracellular membrane compartments, including endosomes and the Golgi. However, the potential occurrence and functional relevance of intracellular signaling for the emerging family of metabolite-sensing GPCRs is largely unknown. Here, we used live-cell imaging, bioluminescence resonance energy transfer (BRET) measurements, and functional readouts to investigate signal compartmentalization of the free fatty acid receptor 4 (FFA4), a prototypical metabolite-sensing GPCR that is activated by medium- and long-chain free fatty acids (FFAs). Unexpectedly, we show that FFA4 largely resides on intracellular membranes that are intimately associated with lipid droplets in adipocytes. Upon lipolysis induction, the released FFAs rapidly bind to and activate this intracellular pool of FFA4, leading to local Gi/ocoupling and inhibition of cAMP production in the vicinity of lipid droplets. This provides a spatiotemporally confined negative feedback mechanism allowing individual lipid droplets to rapidly adjust their lipolysis rate. Our results reveal a novel ‘intracrine’ signaling modality by a prototypical metabolite-sensing GPCR and identify a new lipid-droplet-associated signaling hub implicated in the rapid regulation of lipid metabolism, with important implications for adipocyte physiology and pharmacology.
Tumors cells with mismatch repair deficiency induce hyperactivation of Pyroptosis resistant to cell membrane damage but are more sensitive to Co-treatment of IFN-γ and TNF-α to PANoptosis
Authors: Li Huiyan , Ni Hengli , Li Ying , Zhou Aijun , Qin Xiaokang , Li Yuqin , Che Liheng , Mo Hui , Qin Chao , Li Jianming
Published: July 2023

Hypermutated neoantigens in cancers with DNA mismatch repair deficiency (dMMR) are prerequisite for favorable clinical responses to immune-checkpoint blockade (ICB) therapy. However, TMB is not significantly associated with favorable prognosis from Preclinical and clinical studies. It implys that except for TMB, other mechanisms should be needed to contribute to successful cancer immunotherapy. We found that the hyperactivation of PANoptotic effective molecules in dMMR tumor cells caused cell membrane damage, and induced ESCRT mediated membrane repair, and protectd tumor cells from the damage caused by Triton X100, while DNA mismatch repair proficient (pMMR) tumor cells were sensitive to Triton X100 mediating cell membrane damage due to the lack of ESCRT mediated membrane repair. There were hyperactivation of GSDMD, GSDME and p-MLKL in dMMR tumor cells. Co-treatment of IFN-γ and TNF-α induced rapid death of dMMR tumor cells by inducing PANoptosis including pyroptosis, apoptosis not necrosis. pMMR tumor cells had defects in PANoptosis pathway and were resistant to co-treatment of IFN-γ and TNF-α. In conclusion, we can activate immune cells to release IFN-γ and TNF-α to overcome resistance to ICB treatment.