bluuebunny/crossref_metadata_2025 huggingface dataset:
Stapler insertion angle toward the esophagus reduces the incidence of early postoperative Roux stasis syndrome after distal gastrectomy in minimally invasive surgery
Authors: Yoshikawa Kozo , Shimada Mitsuo , Tokunaga Takuya , Nakao Toshihiro , Nishi Masaaki , Takasu Chie , Kashihara Hideya , Wada Yuma , Yoshimoto Toshiaki
Published: March 2023

Background

Roux stasis syndrome (RSS) after Roux-en-Y (RY) reconstruction significantly prolongs the hospital stay and decreases the quality of life. The purpose of the present study was to evaluate the incidence of RSS in patients who underwent distal gastrectomy for gastric cancer and to identify the factors related to the development of RSS after mechanical RY reconstruction in minimally invasive surgery (MIS).

Methods

This study included 134 patients who underwent distal gastrectomy in MIS with mechanical RY anastomosis. RSS was defined as the presence of symptoms such as nausea, vomiting, or abdominal fullness, and the confirmation of delayed gastric emptying on imaging or gastrointestinal fiber testing. Clinical data were checked, including body mass index, operative procedure, age, sex, operative time, blood loss volume, extent of lymph node dissection, final stage, stapler insertion angle, method of entry hole closure. The relationship between the incidence of RSS and these factors was analyzed.

Results

RSS occurred in 24 of 134 patients (17.9%). RSS occurred significantly more frequently in patients with D2 lymphadenectomy than in patients with D1 + lymphadenectomy (p = 0.04). All patients underwent side-to-side anastomosis via the antecolic route. The incidence of RSS was significantly greater in patients with a stapler insertion angle toward the greater curvature (n = 20, 22.5%) versus the esophagus (n = 4, 8.9%) (p = 0.04). The multivariate logistic regression model revealed that the stapler insertion angle to the greater curvature is identified as independent risk factor for RSS (OR 3.23, 95%Cl 1.01–10.3, p = 0.04).

Conclusion

Stapler insertion angle toward the esophagus may reduce the incidence of early postoperative RSS rather than toward the greater curvature.
Significance of cholecystectomy in cytoreductive surgery for advanced ovarian cancer
Authors: Son Joo-Hyuk , Dong Su Ryeon , Kim Jisoo , Kim Jeeyeon , Kong Tae-Wook , Chang Suk-Joon
Published: March 2023

Background

There have been no studies concerning the complications or benefits of cholecystectomy in ovarian cancer. In this study, we aimed to evaluate the outcomes of cholecystectomy performed during various time periods of the disease course and suggest a management strategy for cholecystectomy in ovarian cancer.

Methods

We retrospectively reviewed the medical records of patients with advanced ovarian cancer who underwent cholecystectomy during the cytoreductive surgery from 2009 to 2020. Cholecystectomy was primarily indicated when the gallbladder and surrounding structures were considered to have metastatic tumor invasion. If the final pathologic results showed free of malignant tumor, patients were placed into the no-infiltration group. Clinical outcomes including the recurrence rate and complications were analyzed.

Results

A total of 62 patients underwent cholecystectomy, 48 of whom (77.4%) underwent cholecystectomy during primary or interval debulking surgery, whereas 14 (22.6%) underwent cholecystectomy during the follow-up period (five with benign disease and 9 with disease recurrence). Among the patients, 32 (51.6%) patients were included in the no-infiltration group in the final pathology. There were no complications observed in the no-infiltration group (n = 32). Seven (78%) of the nine patients who received cholecystectomy for disease recurrence had metastatic disease in the porta-hepatis or lesser sac at the time of primary surgery. However, no recurrent lesions were observed around the porta-hepatis in patients who received cholecystectomy during primary treatment.

Conclusion

Considering the safety of the procedure, as well as the risk of disease recurrence or cholecystitis, a cholecystectomy can be offered to patients with ovarian cancer who have metastatic lesions around the gallbladder and porta-hepatis at the time of primary surgery.
An insight of pathological anatomy of urethral stricture and surgical manipulations for children suffered from hypospadias
Authors: Xiao Yuanhong
Published: March 2023

Background

Manipulation of urethral stricture is difficult and challenging. Accurate analysis and evaluation of the pathological circumstances of narrowed urethra and surrounding tissues were important for cure. The detailed descriptions of anatomic pathology of urethral stricture are rare. An insight of the pathological anatomy of the strictured urethra and the corresponding corrections is essential for an ultimate cure. The aim of the study is to interpret the pathological anatomies of the strictured urethra and the corresponding surgical manipulations.

Methods

From April 2007 to April 2020, eight boys who suffered from postoperative urethral stricture for hypospadias correction were studied retrospectively. The pathological anatomies of the strictured urethra were described and the corresponding surgical manipulations were analyzed.

Results

All eight patients were eventually cured through surgery. The patient age was 2.58–11 years old (mean value of 4.73). The therapeutic duration was 12–130 months (mean value of 47.75). The surgical manipulation was 1–9 times (mean value of 4.5). Curative follow-up was 8–138 months (mean value of 77.75). They were all applied with flap tubularization for their primary urethroplasty.

Conclusions

Based on the principal contradiction of the pathological anatomies of the urethral stricture, one-stage or staged surgical manipulations can be applied. After stricture was resolved, refining techniques of Mathieu, TIP, modified Duckett, glanular reconstruction and et al. can be used. Although it was tiring, utilizing the ventral or dorsal penile flap with relatively good blood supply and flexibility to reconstruct the urethra is possible and successful. To reconstruct an anatomically normal urethral tract should be pursued in the primary and consequential procedures for hypospadias and urethral stricture.
A retrospective cohort study of tamoxifen versus surgical treatment for ER-positive gynecomastia
Authors: He Weili , Wei Weidong , Zhang Qing , Lv Rongzhao , Qu Shaohua , Huang Xin , Ma Juan , Zhang Ping , Zhai Hening , Wang Ningxia
Published: March 2023

Background

Gynecomastia is a common condition in clinical practice. The present study aimed to review the clinical data of ER-positive gynecomastia patients treated by tamoxifen (TAM) versus surgery and discussed the clinical effects of the two treatment strategies.

Method

We retrospectively collected the clinical indicators of patients with unilateral or bilateral gynecomastia who received treatment at our hospital between April 2018 and December 2021. Depending on the treatment received, the patients were divided into TAM and surgery groups.

Result

A total of 170 patients were recruited, including 91 patients in TAM group and 79 patients in surgery group. The age of the patients differed significantly between the TAM and surgery groups (P < 0.01). The estrogen level was closer in patients with stable and progressive disease, but significantly different in patients of glandular shrinkage in TAM group (P < 0.01). The proportion of patients achieving stable disease was higher among those with clinical grade 1–2. Among patients classified as clinical grade 3, the proportion of patients achieving glandular shrinkage of the breast was higher after TAM treatment (P < 0.05). The age and length of hospital stay were significantly different in patients undergoing open surgery than minimally invasive rotary cutting surgery and mammoscopic-assisted glandular resection (P < 0.01). Patients had significantly different complications including mild postoperative pain, hematoma, nipple necrosis, nipple paresthesias and effusions among the surgery subgroups (all P < 0.05). The estrogen level and the type of surgery were significantly different between the surgical recurrence and non-recurrence subgroups (P < 0.05). The difference in the thickness of glandular tissues upon the color Doppler ultrasound also reached a statistical significance between the two groups (P = 0.050). An elevated estrogen level was a factor leading to TAM failure. Among surgical patients, the thickness of glandular tissues, estrogen level, and type of surgery performed were risk factors for postoperative recurrence (all P < 0.05).

Conclusion

Both treatment strategies can effectively treat gynecomastia, but different treatment methods can benefit different patients. TAM treatment is more beneficial than surgery for patients who cannot tolerate surgery, have a low estrogen level, and are clinical grade 1–2. Surgery treatment is better than TAM for patients of clinical grade 3. Different surgery options may lead to different complications. Patients with a greater glandular tissue thickness and a higher estrogen level were shown to have a higher risk of recurrence.
Correlation of asprosin and Nrg-4 with type 2 diabetes Mellitus Complicated with Coronary Heart Disease and the Diagnostic Value
Authors: Zhong Min , Tian Xue , Sun Qitian , Li Lihui , Lu Yanan , Feng Zengbin , Gao Yu , Li Shuying
Published: March 2023

Purpose

Asprosin is a newly discovered adipose factor secreted by white fat, which is involved in glucose metabolism and inflammation. Neuregulin-4 (Nrg-4) is a new adipose factor released from brown adipose tissue and is considered to play an important role in metabolism. This study aims to explore the association between serum Asprosin, Nrg-4 level and coronary heart disease(CHD) in patients with type 2 diabetes mellitus(T2DM) and the diagnostic value.

Patients and methods

157 patients with T2DM were enrolled from Affiliated Hospital of Chengde Medical University between December 2020 to July 2021. These patients were divided into T2DM without CHD group (T2DM-0, n = 80) and T2DM with CHD (T2DM-CHD, n = 77). Serum Asprosin and Nrg-4 expression was detected by enzyme-linked immunosorbent assay, and the correlations between Asprosin or Nrg-4 and clinical and biochemical indicators were analyzed. A receiver operating characteristics curve analysis and area under the curve (AUC) were used to evaluate diagnostic accuracy.

Results

Serum Asprosin level of the T2DM-CHD group were significantly higher and Nrg-4 level significantly lower than those of the T2DM-0 group.Spearman correlation analysis showed that serum Asprosin levels were significantly positively correlated with diabetes course,history of hypertension, fasting plasma glucose(FPG), glycosylated hemoglobin A1c(HbA1C), triglycerides(TG),triglyceride glucose index(TyG index) and urea, and negatively correlated with ALT (all p < 0.05). Nrg-4 was negatively correlated with history of hypertension, body mass index(BMI), FPG, HbA1C, TG, and TyG indexes (all p < 0.05), and positively correlated with high-density lipoprotein cholesterol(HDL-C)(p < 0.05).Logistic regression analysis showed that after adjusting potential confounders, Asprosin was a risk factor for diabetes mellitus, Nrg-4 was a protective factor.The AUC of Asprosin for diagnosing T2DM-CHD was 0.671 (95% confidence interval [CI] 0.584–0.759), and the AUC of the Nrg4 index for diagnosing T2DM-CHD was 0.772 (95% CI 0.700-0.844). The AUC of Asprosin and Nrg-4 for the combined diagnosis of T2DM-CHD was 0.796 (95% CI 0.726–0.864).

Conclusion

Asprosin and Nrg-4 may be novel diagnostic biomarkers for T2DM with CHD, as they effectively improved the diagnostic accuracy for T2DM-CHD.
Antimicrobial and cleaning effects of ultrasonic-mediated plasma-loaded microbubbles on Enterococcus faecalis biofilm: an in vitro study
Authors: Zhu Mengqian , Dang Jie , Dong Feihong , Zhong Ruoqing , Zhang Jue , Pan Jie , Li Yinglong
Published: March 2023

Background

Enterococcus faecalis (E. faecalis) is the most frequently isolated bacteria from teeth with root canal treatment failure. This study aims to evaluate the disinfection effect of ultrasonic-mediated cold plasma-loaded microbubbles (PMBs) on 7d E. faecalis biofilm, the mechanical safety and the mechanisms.

Methods

The PMBs were fabricated by a modified emulsification process and the key reactive species, nitric oxide (NO) and hydrogen peroxide (H2O2) were evaluated. The 7d E. faecalis biofilm on human tooth disk was constructed and divided into the following groups: PBS, 2.5%NaOCl, 2%CHX, and different concentrations of PMBs (108 mL−1, 107 mL−1). The disinfection effects and elimination effects were verified with confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). Microhardness and roughness change of dentin after PMBs treatment were verified respectively.

Results

The concentration of NO and H2O2 in PMBs increased by 39.99% and 50.97% after ultrasound treatment (p < 0.05) respectively. The CLSM and SEM results indicate that PMBs with ultrasound treatment could remove the bacteria and biofilm components effectively, especially those living in dentin tubules. The 2.5% NaOCl presented an excellent effect against biofilm on dishes, but the elimination effect on dentin tubules is limited. The 2% CHX group exhibits significant disinfection effect. The biosafety tests indicated that there is no significant changes on microhardness and roughness after PMBs with ultrasound treatment (p > 0.05).

Conclusion

PMBs combined with ultrasound treatment exhibited significant disinfection effect and biofilm removal effect, the mechanical safety is acceptable.
Efficacy of a four-curvature auxiliary arch at preventing maxillary central incisor linguoclination during orthodontic treatment: a finite element analysis
Authors: Yang Ping-Zhu , Bai Li-Yun , Zhang He-Xuan , Zhao Wen-Jun , liu Yu , Wen Xiu-Jie , Liu Rui
Published: March 2023

Background

Correct torque of the incisors is beneficial in the assessment of the effects of orthodontic treatment. However, evaluating this process effectively remains a challenge. Improper anterior teeth torque angle can cause bone fenestrations and exposure of the root surface.

Methods

A three-dimensional finite element model of the maxillary incisor torque controlled by a homemade four-curvature auxiliary arch was established. The four-curvature auxiliary arch placed on the maxillary incisors was divided into four different state groups, among which 2 groups had tooth extraction space retracted traction force set to 1.15 N. Initial displacements and pressure stresses of the periodontal tissue in the maxillary incisors and molars were calculated after torque forces (0.5, 1, 1.5, and 2 N) were applied to the teeth at different stable states.

Results

The effect of using the four-curvature auxiliary arch on the incisors was significant but did not affect the position of the molars. Given the absence of tooth extraction space, when the four-curvature auxiliary arch was used in conjunction with absolute anchorage, the recommended force value was < 1.5 N. In the other 3 groups (i.e., molar ligation, molar retraction, and microimplant retraction groups), the recommended force value was < 1 N. The application of a four-curvature auxiliary arch did not influence the molar periodontal and displacement.

Conclusion

A four-curvature auxiliary arch may treat severely upright anterior teeth and correct cortical fenestrations of the bone and root surface exposure.
Evaluation of oral brush liquid-based cytology for oral squamous cell carcinoma: a comparative study of cytological and histological diagnoses at a single center
Authors: Kokubun Katsutoshi , Nakajima Kei , Yamamoto Kei , Akashi Yoshihiko , Matsuzaka Kenichi
Published: March 2023

Purpose

Liquid-based cytology is highly useful in oral cytology. However, there are only few reports on the accuracy of this method. The current study aimed to compare oral liquid-based cytological and histological diagnoses and to evaluate items that should be considered in oral cytological diagnosis for oral squamous cell carcinoma.

Methods

We included 653 patients who underwent both oral cytological and histological examinations. Data on sex, specimen collection region, cytological and histological diagnoses, and histological images were reviewed.

Results

The overall male-to-female ratio was 1:1.18. The tongue was the most common specimen collection region, followed by the gingiva and buccal mucosa. The most common cytological examination result was negative (66.8%), followed by doubtful (22.7%) and positive (10.3%). The sensitivity, specificity, positive predictive value, and negative predictive value of cytological diagnosis were 69%, 75%, 38%, and 92%, respectively. Approximately 8.3% of patients with a negative cytological diagnosis had a histological diagnosis of oral squamous cell carcinoma. Furthermore, 86.1% of histopathologic images of cytology-negative squamous cell carcinomas exhibited well-differentiated keratinocytes lacking atypia on the surface. The remaining patients developed recurrence, or they had low cell counts.

Conclusion

Liquid-based cytology is useful in screening oral cancer. However, a cytological diagnosis of superficial-differentiated oral squamous cell carcinoma is occasionally inconsistent with the histological diagnosis. Therefore, histological and cytological examinations should be performed if tumor-like lesions are suspected clinically.
Stability of vertical dimension following total arch intrusion
Authors: Kang Dong-Ok , Yu Hyung-Seog , Choi Sung-Hwan , Kim Seong-Taek , Jung Hwi-Dong , Lee Kee-Joon
Published: March 2023

Background

The purpose of this study is to evaluate stability of vertical dimension following total arch intrusion using miniscrews by measuring the change during treatment and relapse amount after more than one year of retention.

Methods

Thirty patients (6 men, 24 women) were included in this study. Lateral cephalographs were taken with conventional radiography at the start of treatment (T0), after treatment (T1), and at least one year after treatment (T2). The evaluation was performed by measuring changes of selected parameters during treatment and the extent of relapse after more than one year.

Results

During total arch intrusion treatment (T1-T0), anterior and posterior teeth intruded significantly. The mean vertical distance between the maxillary posterior teeth and palatal plane was reduced by 2.30 mm (P < 0.001). The mean vertical distance between the maxillary anterior teeth and palatal plane was reduced by 2.04 mm (P < 0.001). The anterior facial height was also reduced by 2.70 mm (P < 0.001). During retention period (T2-T1), the vertical distance between the maxillary anterior teeth and the palatal plane significantly increased by 0.92 mm (P < 0.001). The anterior facial height increased by 0.81 mm (P < 0.01).

Conclusions

Anterior facial height significantly decreases after treatment. During retention period, relapse of AFH and maxillary anterior teeth observed. There was no correlation between initial amount of AFH, mandibular plane angle, or SNPog and posttreatment AFH relapse. However, there was a significant correlation between the amount of intrusion of anterior and posterior teeth achieved by the treatment and the extent of relapse.
Oral health related quality of life of oral cancer patients treated with radiotherapy alone or with chemotherapy in a tertiary referral centre in Sri Lanka
Authors: Kosgallana Shamini , Jayasekara Prasanna , Abeysinghe Prasad , Lalloo Ratilal
Published: March 2023

Background

Oral cancer is the number one cancer among males in Sri Lanka. Radiotherapy is a common treatment modality for oral cancer, but this can affect oral health related quality of life (OHRQOL). This study assessed the OHRQOL and its changes from baseline to the last week of radiotherapy and three months post radiotherapy among oral cancer patients who received this treatment alone or with chemotherapy.

Methods

A prospective longitudinal study was conducted among 90 oral cancer patients awaiting for radiotherapy alone or with chemotherapy. The modified Sinhala version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Oral Health Module (EORTC QLQ-OH15) was used to gather data related to OHRQOL before radiotherapy. Socio-demographic and clinical data were also recorded. The same cohort of patients were followed up and assessed their OHRQOL during the last week of radiotherapy and three months post radiotherapy. The Modified EORTC QLQ-OH15 assesses the OHRQOL under three domains namely ‘Eating problem’, ‘Gum and speech problem’and‘Soreness’, and one item named as‘Teeth’.

Results

The majority of the sample (88%) was males. The anterior two-thirds of the tongue (40%) and buccal mucosa (22%) were the most common sites. The median scores of ‘Eating problem’domain at baseline, last week of radiotherapy and three months post radiotherapy were 20 (IQR = 6.7–33.3), 100 (IQR = 86.9–100.0) and 66.7 (IQR = 46.7–93.3) respectively. ‘Gum and speech problem’was higher during last week of radiotherapy (median, 50.0, IQR, 25.0-58.3) than three months post radiotherapy (median, 8.3, IQR, 0.0-33.3). The changes of OHRQOL between the time frames were statistically significant (p < 0.05). Baseline OHRQOL in relation to ‘Gum and speech problem’domain and‘Teeth’item was identified as an influential factor for OHRQOL during last week of radiotherapy.

Conclusion

The OHRQOL of oral cancer patients who received radiotherapy alone or with chemotherapy had deteriorated from the baseline level to the last week of radiotherapy but then improved at three months post radiotherapy. The OHRQOL however did not return to the baseline level three months post radiotherapy. OHRQOL during the last week of radiotherapy was influenced by the OHRQOL at baseline, civil status and sites of metastasis.
Retrospective study on the therapeutic efficacy of zinc acetate hydrate administration to patients with hypozincemia-induced dysgeusia
Authors: Shintani Tomoaki , Ohta Kouji , Ando Toshinori , Hayashido Yasutaka , Yanamoto Souichi , Kajiya Mikihito , Shiba Hideki
Published: March 2023

Background

Dysgeusia is a relatively early symptom of zinc deficiency, and zinc replacement is effective in treating dysgeusia. The administration of zinc acetate hydrate (ZAH) was approved in 2017 for patients with hypozincemia in Japan. This retrospective study was conducted to explore the efficacy and safety of ZAH administration in patients with hypozincemia-induced dysgeusia.

Methods

Patients with hypozincemia-induced dysgeusia who visited our hospital from May 2013 to December 2019 were included in this study. ZAH (zinc content; 50 mg/day) was administered to 42 patients for 24 weeks. The taste test was performed using the filter paper disk method, and the total cognitive thresholds of the left and right chorda tympani regions were used. Changes in taste function, serum zinc and copper levels, and copper/zinc ratio were analyzed. A total of 28 patients who received polaprezinc (PPZ, zinc content; 34 mg/day) for 24 weeks, who were prescribed until ZAH was approved, were registered as controls.

Results

Serum zinc levels at 12 and 24 weeks after ZAH or PPZ administration were higher than those before administration. These levels were significantly higher in the ZAH-treated group than in the PPZ-treated group. However, serum copper levels did not significantly change before and after administration. In the taste test, the taste thresholds for the acidity and salty at 12 and 24 weeks after ZAH administration were significantly decreased compared to before administration. In contrast, in the PPZ group, the taste thresholds for the acidity and salty were significantly decreased 24 weeks after administration.

Conclusions

ZAH (50 mg/day) administration was effective in improving the gustatory sensitivity of patients with dysgeusia and hypozincemia 12 weeks after administration without affecting the serum copper level. ZAH was also more effective than PPZ.
Oral status and affecting factors in Iranian ICU patients: a cross-sectional study
Authors: Arkia Mostafa , Rezaei Jahangir , Salari Nader , Vaziri Siavash , Abdi Alireza
Published: March 2023

Background

Oral care is crucial in intensive care units (ICUs). Meanwhile, this action is not well-performed, therefore, mouth cavity-associated disorders cause serious outcomes, e.g. ventilator-dependent pneumonia. Considering a lack of studies in Iran on this subject, this study aimed to determine the oral status and affected factors in ICU patients in Iran.

Methods

In a cross-sectional study in 2019, we assessed the oral status of 138 patients admitted to the ICUs in the Kermanshah and Ilam provinces by census method. The tools were a demographic and clinical characteristics checklist, and Beck's oral status assessment scale (BOAS). The researcher investigated the condition of the patient's mouth, and their records. Data were analyzed using descriptive and inferential statistics.

Results

In this study, the prevalence of moderate and severe disorders of the lips, gums and oral mucosa, tongue, teeth, and saliva were 14.4, 26.1, 16.6, 49.3, and 34.8 percent, respectively. Six percent of patients had a normal oral condition. Oral status had a significant relationship with education level, age, marital status, brushing teeth, NG tube, and consciousness level.

Conclusion

Compared to other studies, the prevalence of oral cavity disorders in ICU patients of the Ilam and Kermanshah provinces was high. It mandates paying crucial attention to nurses' continued education, using standard guidelines, and applying new facilities. Moreover, it is mandated for periodical visits of patients by a dentist in ICUs.
Cleaning efficacy of EDDY versus ultrasonically-activated irrigation in root canals: a systematic review and meta-analysis
Authors: Chu Xiaojun , Feng Shuting , Zhou Weiqing , Xu Shuaimei , Zeng Xiongqun
Published: March 2023

Background

Ultrasonically-activated irrigation (UAI) is effective in root canal irrigation but may damage canal walls. EDDY is a sonic activation system with flexible working tips that cause no harm to dentinal walls. This review explores the intracanal cleaning efficacy of EDDY compared with UAI in vitro.

Methods

The systematic review was registered in the PROSPERO database (CRD42021235826). A literature search was conducted in six electronic databases. In vitro studies that compared the removal of smear layer, debris, soft tissue or microbes in root canals between EDDY and UAI were included. Data extraction and quality assessment were performed. Meta-analyses were conducted on smear layer removal and debris elimination with the standardized mean difference (SMD). Heterogeneity was measured using the I2test and the Chi2test. The random-effect model was used when I2 > 50%, orp < 0.1, otherwise the fixed-effect model was applied. The level of significance was set atp < 0.05.

Results

19 articles were included in this systematic review and 7 articles were included in meta-analyses. Meta-analyses on smear layer removal showed unimportant differences between EDDY and UAI at any canal third (coronal [SMD = 0.08, 95% confidence interval (95%CI): -0.29 to 0.45;p = 0.44, I2 = 0%]; middle [SMD = 0.02, 95% CI: -0.44 to 0.47;p = 0.94, I2 = 0%]; apical [SMD = 0.01, 95%CI: -0.35 to 0.38;p = 0.70, I2 = 0%]). Meta-analyses on debris removal evaluated by scanning electron microscope (coronal [SMD = 0.03, 95% CI: -0.41 to 0.46;p = 0.27, I2 = 23%]; middle [SMD = -0.24, 95% CI: -0.83 to 0.35;p = 0.80, I2 = 0%]; apical [SMD = 0.24, 95%CI: -0.20 to 0.67;p = 0.36, I2 = 2%]) and micro-CT (SMD = 0.36, 95% CI: -0.67 to 1.40;p = 0.03, I2 = 70%) both found insignificant differences. No meta-analysis was undertaken on soft-tissue removal and disinfection due to the various study designs, but the qualitative analyses implied that EDDY achieved similar performance to UAI in both aspects.

Conclusions

Limited evidence indicated that EDDY was comparable to UAI in removing smear layer, debris, soft tissue and microbes ex vivo. Considering UAI may damage canal walls, EDDY might be a substitute for UAI in irrigation activation. But more randomized clinical trials are required to explore the clinical extrapolation of the results in this review.
Implications of serum uric acid for female infertility: results from the national health and nutrition examination survey, 2013–2020
Authors: Liang Jiemei , Chen Xiting , Huang Jinfa , Nie Weizhe , Yang Qian , Huang Qitao , Deng Kaixian
Published: March 2023

Background

There is limited concrete evidence connecting serum uric acid levels to female infertility. Therefore, this study aimed to find out if serum uric acid levels are independently related to female infertility.

Methods

From the National Health and Nutrition Examination Survey (NHANES) 2013–2020, a total sample of 5872 chosen female participants between the ages of 18 and 49 were identified for this cross-sectional study. The serum uric acid levels (mg/dL) of each participant were tested, and the reproductive health questionnaire was used to evaluate each subject's reproductive status. Both in the analyses of the full sample and each subgroup, logistic regression models were used to evaluate the relationship between the two variables. A stratified multivariate logistic regression model was used to perform the subgroup analysis based on serum uric acid levels.

Results

Infertility was found in 649 (11.1%) of the 5,872 female adults in this study, with greater mean serum uric acid levels (4.7 mg/dL vs. 4.5 mg/dL). Serum uric acid levels were associated with infertility in both the initial and adjusted models. According to multivariate logistic regression, the odds of female infertility were found to be significantly higher with rising serum uric acid levels (Q4 [≥ 5.2 mg/dL] vs. Q1 [≤ 3.6 mg/dL]), adjusted odds ratio [aOR] = 1.59, p = 0.002]. The data suggests that there is a dose–response relationship between the two.

Conclusions

The results from this nationally representative sample from the United States confirmed the idea that there is a link between increased serum uric acid levels and female infertility. Future research is necessary to evaluate the relationship between serum uric acid levels and female infertility and explicate the underlying mechanisms of this relationship.
PCGEM1 promotes cell proliferation and migration in endometriosis by targeting miR-124-3p-mediated ANTXR2 expression
Authors: Liu Yong , Xie Chengmao , Li Ting , Lu Chang , Fan Linyuan , Zhang Zhan , Peng Sha , Lv Na , Lu Dan
Published: March 2023

Background

Endometriosis, a common gynaecological disease in women, affects 10% of women of childbearing age. Among infertile women, this proportion is as high as 30–50%. Despite the high prevalence of endometriosis, the pathogenesis of endometriosis is still unclear.

Methods

In the present study, bioinformatics analysis and molecular and animal experiments were employed to explore the functions of PCGEM1 in the pathogenesis of endometriosis. We established an endometriosis rat model and isolated endometrial stromal cells (ESCs) and primary normal ESCs (NESCs). Bioinformatics analysis was adopted to study the roles of PCGEM1 in promoting the pathogenesis of endometriosis. Luciferase reporter assays and RNA pull-down assays were carried out to study the mechanism by which PCGEM1 regulates ANTXR2.

Results

Our results indicated that PCGEM1 promoted the motility and proliferation of ectopic endometrial cells, and the underlying mechanism was due to the direct binding of PCGEM1 to miR-124-3p to modulate ANTXR2 expression.

Conclusion

PCGEM1 can influence endometrial stromal cell proliferation and motility and may be a novel therapeutic target for endometriosis.
Factors associated with late diagnosis of breast cancer in women in Togo, Sub-Saharan Africa
Authors: Darré Tchin , Tchandikou Lantam , Simgban Panakinao , Bombone Mayi , Djiwa Toukilnan , N’Timon Bidamin , Sama Bagassam , Ketevi Ayoko , Douaguibe Baguilane , N’Bortche Bingo K. , Seddoh Yao , Tchaou Mazamaesso , Napo-Koura Gado
Published: March 2023

Background

Breast cancer is the most frequently diagnosed cancer in women worldwide. The objective of this study was to identify factors associated with late diagnosis of breast cancer in Togolese women.

Methods

We conducted a prospective cross-sectional study with descriptive and analytical purposes on cases of breast cancer in women in 2021, in Togo. The patients included in this study were women followed in the gynecology department for stages III and IV breast cancer.

Results

We included 62 cases of breast cancer. The average age of the patients was 38.6 ± 12.5 years with extremes of 17 and 76 years. The breast nodule was the most common reason for consultation in 75.8% of cases. The histological types diagnosed were invasive carcinoma of non-specific type (58; 93.55%), mucinous carcinoma (3; 4.84%) and lobular carcinoma (1; 1.61%). For the stage of the cancer, 43 patients were stage III (69.4%) and 19 stage IV (30.6%).

In multivariate analysis, the factors associated with late diagnosis of breast cancer were: fear of diagnosis (aOR = 1.29;p = 0.0014), long delay in diagnosis (aOR = 2.62;p = 0.0001) and failure to perform breast self-examination (aOR = 1.68;p = 0.0022).

Conclusion

The fear of the diagnosis, the absence of self-examination of the breasts and the use of traditional treatment and self-medication in first intention constituted the essential factors of the late diagnosis of breast cancer. Strategies should be put in place at the national level to impact on these factors for an early diagnosis of breast cancer.
Adherence to oral anticancer hormonal therapy in breast cancer patients and its relationship with treatment satisfaction: an important insight from a developing country
Authors: Koni Amer A. , Suwan Bushra A. , Nazzal Maisa A. , Sleem Alaa , Daifallah Aiman , allah Majd Hamed , Odeh Razan Y. , Zyoud Sa’ed H.
Published: March 2023

Background

Hormone-positive breast cancer is the most common type and represents a burden in all countries. Treatment satisfaction might be a predictor for adherence, as higher satisfaction with medication encourages patients to adhere appropriately to the medication and, consequently, successfully achieve the treatment goals. The present study evaluated the adherence of women with hormone-positive breast cancer to oral hormonal drugs and correlated it with treatment satisfaction and other sociodemographic and clinical factors.

Methods

A cross-sectional design was applied. This study included two cancer centers. Data were collected from patients through face-to-face interviews and medical record reviews. The Medication Adherence Scale was adapted to assess medication adherence, and the Treatment Satisfaction Questionnaire for Medication (TSQM) version 1.4 was adopted to measure treatment satisfaction.

Results

The final analysis included 106 patients, with a mean age ± SD of 51.9 ± 1.2. Approximately 35% were hospitalized in the past year. Current hormonal therapy among cancer patients included letrozole (38.7%), tamoxifen (31.1%), exemestane (17%), and anastrozole (13.2%). The median adherence score was 5.0 [4.8–6.0], and 62.3% adhered fully to their oral hormonal drugs in the past week. The median scores of effectiveness, side effects, convenience, and global satisfaction were 66.67 [61.11.0–72.22], 75.00 [48.44–100.00], 66.67 [66.67–72.22], and 71.43 [57.14–78.57], respectively. A significantly lower adherence score was identified in patients living in camps (p = 0.020). Patients with comorbidities and those who continued on the same hormonal therapy had higher adherence scores, although they were not statistically significant. Multiple linear regression analysis showed that two domains of treatment satisfaction, side effects (p = 0.013) and global satisfaction (p = 0.018), were predictors of adherence to oral hormonal drugs.

Conclusions

The current study revealed a significant association between treatment satisfaction and adherence to oral hormonal therapy. We recommend creating a specialized scale to measure adherence, considering the psychosocial factors that affect hormonal anticancer medication adherence.
Long-term pelvic floor symptoms and urogenital prolapse after hysterectomy
Authors: Vermeulen Carolien K. M. , Veen Joggem , Adang Caroline , Coolen Anne Lotte W. M. , van Leijsen Sanne A. L. , Bongers Marlies Y.
Published: March 2023

Background

The aim of this study was to describe the natural course of pelvic floor symptoms and pelvic floor anatomy for women long-term after hysterectomy.

Methods

Women who underwent hysterectomy between 1996–2004 carried out the PFDI-20 questionnaire and POP-Q examination. We collected data on the presence and type of pelvic floor symptoms and its relation to the degree of pelvic organ prolapse (POP) per compartment (≥ stage 2).

Results

We obtained data from 247 women on average sixteen years after hysterectomy, with no prolapse (n = 94), anterior prolapse (n = 76), posterior prolapse (n = 38), both anterior- and posterior prolapse (n = 20), and a prolapse involving the vaginal vault (n = 19). Of all 153 women with ≥ stage 2 prolapse, 80 (52%) experienced moderate and/or severe symptoms of the PFDI-20. Most frequently reported symptoms by women with POP were uncontrollable flatus, urinary frequency and urge incontinence. Bulging was associated with a prolapse beyond the hymen. 39% Of women without prolapse experienced bothersome pelvic floor symptoms as well. Most often these were stress incontinence, straining to pass stool and incomplete bowel emptying. Women with a history of hysterectomy for prolapse have more pelvic floor symptoms than women who underwent hysterectomy for other indications, regardless of the current presence of POP (57% versus 40%, p = 0.009).

Conclusion

In a group of post-hysterectomy women who did not actively seek help, 47% experienced problematic pelvic floor symptoms, independent of the presence or absence of an anatomic POP. Creating more knowledge and awareness of the impact of hysterectomy on the pelvic floor can help women in the future.

Trial registration

The study was registered in the Dutch Trial Registry; Trial NL5967 (NTR6333, 2017–02-01) and approved by the Medical Research Ethics Committee of the Máxima Medical Center (NL60096.015.16, 2017–02-24).
Heracleum persicum Desf. ex Fisch., C.A.Mey. & Avé-Lall. fruit essential oil: content, antimicrobial activity and cytotoxicity against ovarian cancer cell line
Authors: Ghavam Mansureh
Published: March 2023

Background

One of the most important aromatic species of the Apiaceae family is Heracleum persicum Desf. ex Fisch., C.A.Mey. & Avé-Lall, which used as a spice and condiment in food. It is widely used in traditional Iranian medicine due to its anti-toxic properties. The aim of this study was to evaluate the essential oil of this plant in terms of content and ingredients, cytotoxicity and antimicrobial activity.

Methods

The fruit of H. persicum was collected in June 2019 from Maragheh region of Kashan, Iran. The essential oil was extracted by water distillation using Clevenger for 3 h. Identification analysis of H. persicum fruit essential oil (HPFEO) components was performed using gas chromatography-mass spectrometry (GC–MS). Evaluation of the effect of the HPFEO on the growth and proliferation of ovarian cancer cell line (OVCAR-3) was performed using MTT colorimetric method. Its antimicrobial activity was evaluated by agar diffusion method, minimum inhibitory concentration (MIC) and minimum bactericidal/fungal lethality concentration (MBC/MFC).

Results

The results of analysis of the HPFEO by GC–MS showed that there were 35 compounds with 99.54% relative content. Hexyl butyrate (35.24%), octyl 2-methylbutyrate (11.65%), octyl isobutyrate (9.23%), and octyl acetate (8.42%) were the predominant compounds. Examination of cell survival showed that the viability of cells decreased depending on the concentration of the HPFEO in 24 h and had value of IC50 ~ 12.08 μg/ml against OVCAR-3 cell line. The strongest inhibitory activity of the HPFEO was against Gram-negative bacteria Pseudomonas aeruginosa and Salmonella paratyphi-A serotype (MIC < 62.50 μg/mL). Also, the strong inhibitory and lethal activity of this essential oil against Candida albicans (MIC and MBC 250 μg/mL was one degree weaker compared to nystatin (MIC = 125 μg/mL).

Conclusions

Thus, HPFEO, in addition to its traditional use, may have a strong and potential potential for the production of anti-proliferative and antimicrobial drugs.
Isorhynchophylline inhibits inflammatory responses in endothelial cells and macrophages through the NF-κB/NLRP3 signaling pathway
Authors: Wang Li-Hua , Gu Zheng-Wei , Li Jie , Yang Wen-Qing , Li Yun-Lun , Qi Dong-Mei , Wang Dan-Yang , Jiang Hai-Qiang
Published: March 2023

Background

Atherosclerosis is a chronic inflammatory disease of arterial wall, which is closely related to inflammatory reaction. In this study, the anti-inflammatory effect of isorhynchophylline was studied by NF- κB / NLRP3 pathway.

Methods

(1) ApoE−/− mice were fed with high-fat diet to establish atherosclerotic model, while C57 with the same genetic background was fed with common diet as control group. Body weight was recorded and blood lipids were detected. The expression of NLRP3, NF-κB, IL-18 and Caspase-1 in aorta was detected by Western-Blot and PCR, and plaque formation was detected by HE and oil red O staining. (2) Lipopolysaccharide interfered with Human Umbilical Vein Endothelial Cells (HUVECs) and RAW264.7 to form inflammatory model, and was treated with isorhynchophylline. The expression of NLRP3, NF-κB, IL-18 and Caspase-1 in aorta was detected by Western-Blot and PCR, and the ability of cell migration was detected by Transwell and scratch test.

Results

(1) the expression of NLRP3, NF- κB, IL-18 and Caspase-1 in aorta of model group was higher than that of control group, and plaque formation was obvious. (2) the expressions of NLRP3, NF- κB, IL-18 and Caspase-1 in HUVECs and RAW264.7 model groups were higher than those in control group, while isorhynchophylline decreased their expression and enhanced cell migration ability.

Conclusion

Isorhynchophylline can reduce the inflammatory reaction induced by lipopolysaccharide and promote the ability of cell migration.
Using standardized patients for undergraduate clinical skills training in an introductory course to psychiatry
Authors: Siemerkus Jakob , Petrescu Ana-Stela , Köchli Laura , Stephan Klaas Enno , Schmidt Helen
Published: March 2023

Background

The goal of this study was to assess the value and acceptance of Standardized or Simulated Patients (SPs) for training clinically inexperienced undergraduate medical students in psychiatric history taking, psychopathological assessment, and communication with psychiatric patients.

Methods

As part of a newly developed introductory course to psychiatry, pairs of 3rd year medical students conducted psychiatric assessments of SPs, including history and psychopathological state, under the supervision of a clinical lecturer. Prior to the assessment, students attended introductory lectures to communication in psychiatry and psychopathology but were clinically inexperienced. After the interview, the students’ summary of their findings was discussed with other students and the lecturer. Students, lecturers, and actors were invited to a survey after the course. Questions for the students included self-reports about perceived learning success and authenticity of the interviews.

Results

41 students, 6 actors and 8 lecturers completed the survey (response rates of 48%, 50%, and 100%, respectively). The survey results indicated that, despite their lack of clinical experience, students learned how to conduct a psychiatric interview, communicate in a non-judgmental and empathetic manner, take a psychiatric history and perform a psychopathological examination. SPs were perceived as authentic. The survey results suggested that this setting allowed for an enjoyable, non-distressful and motivating learning experience within a restricted time frame of just two afternoons.

Conclusion

The results indicated that the SP approach presented is useful for teaching clinical skills in psychiatry to students with limited previous clinical experience and knowledge of psychiatry. We argue that SPs can be used to teach practical psychiatric skills already during an early phase of the curriculum. Limitations of our study include a limited sample size, a temporal gap between the course and the survey, reliance on self-reports, and lack of comparison to alternative interventions.
A study of validity and usability evidence for non-technical skills assessment tools in simulated adult resuscitation scenarios
Authors: Higham Helen , Greig Paul , Crabtree Nick , Hadjipavlou George , Young Duncan , Vincent Charles
Published: March 2023

Background

Non-technical skills (NTS) assessment tools are widely used to provide formative and summative assessment for healthcare professionals and there are now many of them. This study has examined three different tools designed for similar settings and gathered evidence to test their validity and usability.

Methods

Three NTS assessment tools designed for use in the UK were used by three experienced faculty to review standardized videos of simulated cardiac arrest scenarios: ANTS (Anesthetists’ Non-Technical Skills), Oxford NOTECHS (Oxford NOn-TECHnical Skills) and OSCAR (Observational Skill based Clinical Assessment tool for Resuscitation). Internal consistency, interrater reliability and quantitative and qualitative analysis of usability were analyzed for each tool.

Results

Internal consistency and interrater reliability (IRR) varied considerably for the three tools across NTS categories and elements. Intraclass correlation scores of three expert raters ranged from poor (task management in ANTS [0.26] and situation awareness (SA) in Oxford NOTECHS [0.34]) to very good (problem solving in Oxford NOTECHS [0.81] and cooperation [0.84] and SA [0.87] in OSCAR). Furthermore, different statistical tests of IRR produced different results for each tool. Quantitative and qualitative examination of usability also revealed challenges in using each tool.

Conclusions

The lack of standardization of NTS assessment tools and training in their use is unhelpful for healthcare educators and students. Educators require ongoing support in the use of NTS assessment tools for the evaluation of individual healthcare professionals or healthcare teams. Summative or high-stakes examinations using NTS assessment tools should be undertaken with at least two assessors to provide consensus scoring. In light of the renewed focus on simulation as an educational tool to support and enhance training recovery in the aftermath of COVID-19, it is even more important that assessment of these vital skills is standardized, simplified and supported with adequate training.