bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Study of Wolf Pack Algorithm and Artificial Bee Colony Algorithm
Authors: Peng Qiang , Zhan Renjun , Wu Husheng , Shi Meimei
Published: August 2024

Swarm intelligence optimization algorithms have been widely used in the fields of machine learning, process control and engineering prediction, among which common algorithms include ant colony algorithm (ACO), artificial bee colony algorithm (ABC) and particle swarm optimization (PSO). Wolf pack algorithm (WPA) as a newer swarm intelligence optimization algorithm has many similarities with ABC. In this paper, the basic principles, algorithm implementation processes, and related improvement strategies of these two algorithms were described in detail; A comparative analysis of their performance in solving different feature-based standard CEC test functions was conducted, with a focus on optimization ability and convergence speed, re-validating the unique characteristics of these two algorithms in searching. In the end, the future development trend and prospect of intelligent optimization algorithms was discussed, which is of great reference significance for the research and application of swarm intelligence optimization algorithms.
Chemical composition and effectiveness of Bay leaf and Cinnamon essential oils against Aflatoxigenic fungi
Authors: Lawal I. O. , Onyegbula A. F. , Oladeinde M. O. , Fashanu T. A. , Yusuf K. A.
Published: August 2024

Spoilage of agricultural produce due to the action of Aspergillus spp. pose significant challenges to farmers and importer/exporter of agricultural produce. Aflatoxins are toxin produced by fungi and they contaminate food threatening food safety. Studies have shown that essential oils are capable of inhibiting the growth of Aspergillus spp. This study determined the chemical composition of the essential oils of Bay leaf and Cinnamon using Gas Chromatography-Mass Spectroscopy (GC-MS) techniques and evaluated the in vitro effect of the oils against Aflatoxigenic fungi (Aspergillus flavus, Aspergillus niger and Aspergillus parasiticus). Food poisoning technique was used to determine the inhibitory effect of the oils with radial mycelia growth of each observed and measured 24 hourly. The result of GC-MS analyses revealed cinnamaldehyde (5.83%), 3-Methyl- Benzofuran (14.49%), 2,6,6,9-tetramethyl-Tricycloundec-9-ene (10.59%) and other bioactive constituents as abundant in the essential oil of Cinnamon. Additionally, Bay leaf essential oil recorded Eucalyptol (12.30%), Eugenol (4.15%), and 2-octyl-Cyclopropaneoctanal (9.16%) among other bioactive compounds. Antifungal result revealed that both oils were active against the studied microorganisms as they were able to completely inhibit the growth of A. niger. Cinnamon oil had 92.69 and 91.27% inhibition against A. flavus and A. parasiticus respectively at 72 hr of observation, while essential oil from Bay leaf recorded 23.50% and 76.50% inhibition for A. flavus and A. parasiticus after 72 hr. Results from this study have further confirmed the antimicrobial potentials of essential oils against the tested Aspergillus spp. and their potential use in the development of natural antifungal products.
Differently processed Sri Lankan traditional rice as a source of oleic, linoleic, and other fatty acids
Authors: Thennakoon T. P. A. U. , Ekanayake Sagarika
Published: August 2024

Introduction: Renewed interest in Sri Lankan traditional rice has led to demonstrate their nutritional and health potential. However, much data is not available on the constituent fatty acids or the effect of processing of rice on fatty acids which are vital in maintaining immunity and many metabolic functions.Objective: To assess the fatty acid profiles of traditional rice subjected to different processing methodsMethods: Six traditional rice varieties; Goda heenati, Batapola el, Dik wee, Dahanala, Unakola samba, and Hangimuththan were processed as raw under milled (unpolished), raw polished (4%), and parboiled under milled. Fat was extracted from cooked and uncooked rice flour of differently processed rice varieties. Extracted fat was hydrolysed, methylated, and subjected to gas chromatography mass spectrophotometry.Results:  Irrespective of processing, the major fatty acid contents of fat of uncooked and cooked rice flour remained as oleic > linoleic> palmitic> stearic acid. Monounsaturated fatty acid, oleic was the most abundant fatty acid found in all differently processed uncooked (35.7-47.6% fat) and cooked rice flour (34.8-44.7% fat). Essential fatty acid, linoleic (18:2) content in the fat of uncooked and cooked rice ranged from 17.9-32% and 18.6-32% respectively. Saturated palmitic acid (C-16) and stearic acid in uncooked and cooked ranged from 13.5-21.5% and 18.2-22.4% and 1.5- 3% and 1.1-3.2%respectively. Consumption of two cups of these traditional rice varieties will provide approximately  4-10% of RDA of linoleic acid.Conclusion: Raw unpolished traditional rice varieties provide the highest amounts of monounsaturated oleic acid and polyunsaturated linoleic acid followed by parboiled and raw polished rice.
A case of acute oxalate nephropathy due to Averrhoa bilimbi (bilin) juice ingestion in Sri Lanka
Authors: Bartholameuz Nuwan , Karunarathne Supipi , Galabada Dinith , Fernandopulle Shanika
Published: August 2024

Bilimbi fruit is widely consumed in Sri Lanka. Its potential to cause acute kidney injury is relatively unknown among Sri Lankans. We report a case of acute oxalate nephropathy in an adult male following bilimbi juice ingestion. Thorough dietary history and awareness of the potential nephrotoxic effects of bilimbi fruits are useful in the evaluation of kidney injury.
The burden of antenatal anxiety: A cross-sectional study of prevalence and selected risk factors among antenatal women in a government hospital in the Colombo district
Authors: Anjalika Tharushi , Arachchi Hashini Epa , Anpuchselvam Arulpiragasam , De Zoysa Piyanjali
Published: August 2024

Introduction: Pregnancy is a challenging period for both the physical and mental health of a woman, increasing her vulnerability to mental health conditions during this period. Antenatal anxiety is one such overlooked condition which can result in adverse outcomes to both mother and child, as well as to their family and larger society.Objective: This study assessed the proportion of antenatal anxiety and factors associated with it among 122 women attending antenatal clinics at a government hospital in the Colombo district.Methods: A descriptive cross-sectional study was conducted among systematically sampled pregnant women attending antenatal clinics. Their level of antenatal anxiety was assessed using the Perinatal Anxiety Screening Scale. An interviewer administered questionnaire was used to collect information on selected socio-demographic, family-related, current pregnancy-related, previous pregnancy-related, health-related factors, and coping skills of the participants.Results: Overall antenatal anxiety among the participants was 42.6%. Among the correlates studied for association with antenatal anxiety, only maternal age, educational level, pregnancy-related medical conditions, younger age of partner, and the women’s choice of coping skills showed a statistically significant association.Conclusions: The high proportion antenatal anxiety in pregnant women calls for further research into this mental health condition, exploring in-depth through mixed methods studies, and also examine cultural appro-priateness of current anxiety scales to assess anxiety in pregnant women. It is important that clinicians assess pregnant women during routine care for such anxiety as well as consider implementing evidence-based psycho-social interventions as a preventative strategy.
Nicosia Master Plan for the Historic Quarters of Selimiye and Omeriye in Cyprus: A Comparative Evaluation
Authors: Pieri C.
Published: August 2024

Following the division of Cyprus in 1974 between the Greek Cypriot (South) and Turkish Cypriot (North) Communities, the island has been dealing with a pluralism of social, economic, political and administrative concerns affecting its heritage as well as heritage management. These concerns are particularly visible in the capital of Nicosia, where the historic core of the city has been equally divided between the two communities and has been managed by separate municipal bodies since then. The Nicosia Master Plan (NMP) was introduced as a bi-communal initiative to assist in collaborative management of the city’s heritage, and to prepare its historic core for a possible future event of re-unification.
Through the assessment of selected NMP initiatives meant for the historic quarters of Selimiye and Omeriye respectively, this paper attempts to critically examine the impact of division (prompted by conflict) on the heritage of Nicosia. This is achieved through evaluation of the effectiveness of NMP’s efforts on each side of the Cypriot divide. The hypothesis here is that the existing buffer zone significantly impacts its adjacent areas, whereby buildings with closer proximity to the border suffer the most. Despite NMP’s overall contribution in safeguarding a significant part of the city’s historic urban core, the findings demonstrate a departure from its broader bi-communal heritage protection trajectory. Furthermore, novel insights into the use of specific heritage rehabilitation methods are presented and critically discussed, shedding light into the future – pertaining to their impending impact, and on the ways these could assist the heritage protection of the walled city.
Integrating Health and Urban Security: Urban Management Approach that Contained COVID-19 Wave-1 in Sri Lanka
Authors: Abewardhana A.A.B.D.P. , Lakmali R.G.M. , Genovese P.V. , Munasinghe H.
Published: August 2024

The rapid transmission of coronavirus (COVID-19) resulted in more than 664.6 million infected patients worldwide by 31st December 2022, with 6.69 million deaths. Despite having formidable medical facilities, the USA, India, France, Germany, Brazil, Japan, South Korea, Italy, UK and Russia etc. were leading the tables in terms of patient numbers. At the epicenter of the pandemic, numerous strategies were adopted around the world to fight the virus. The ever-changing nature of the threat made it even deadlier in a safety perspective, as the enemy was undetectable in the form of a virus that endangered human existence. A change in the perception of ‘threat’ in terms of a security viewpoint was fostered; from a ‘visible’ to an ‘invisible’ one. The early intervention with the military being placed in control in urban/rural areas was identified as an effective grassroots level means to control the virus in Sri Lanka. In this context, COVID-19 was considered as a security threat than a health threat. The Chinese way of source control, spread control and virus tracing was carried out by the Sri Lankan military as well as police in order to contain its spread. Approximately ten weeks of Sri Lanka’s progress that was recorded during wave-1 of the pandemic has been discussed here, in comparison to examples from around the world. In this light, the paper attempts justification of the successful military-led urban management system as it happened in Sri Lanka, so it could be applied elsewhere.
What do women with epilepsy know about pregnancy?
Authors: Baloyi Miyalani G. , Khalema Rethabile , Adam Sumaiya
Published: August 2024

Background: Understanding the intersection of epilepsy and pregnancy, including knowledge gaps and healthcare access for women with epilepsy (WWE), is critical. This study evaluated WWE knowledge gaps and information needs concerning epilepsy’s impact on their sexual and reproductive health during pregnancy and examined healthcare system factors affecting their access to information, aiming to identify areas for improvement in educational and healthcare strategies to enhance health management for WWE.Methods: From July 2022 to June 2023, 111 WWE aged 18 to 40 years were recruited from the family medicine and internal medicine outpatient departments at Steve Biko Academic Hospital, Tembisa Tertiary Hospital (TTH), and Kalafong Hospital. Interviews assessed various aspects related to epilepsy in pregnancy and contraceptive use.Results: The study found strong links between WWE, their demographics, and their awareness of pregnancy-related epilepsy issues. Participants from TTH showed notably higher awareness (85.5%) of risks from epilepsy and AED during pregnancy (p  0.05). Age and education significantly influenced pregnancy planning and understanding of medication risks. Younger women (20–25 years) were more inclined towards future pregnancies, and those with more education were better informed about medication risks (p  0.05); and 68.5% had received counselling on AED and contraceptive interactions, yet only 16.2% knew AED could reduce contraceptive effectiveness.Conclusion: The study reveals significant knowledge gaps in WWE regarding the impact of epilepsy and AED on pregnancy, suggesting tailored educational and counselling initiatives to improve WWE health outcomes and quality of life, advancing chronic disease management and public health objectives.Contribution: The study highlights substantial knowledge gaps in epilepsy during pregnancy among WWE, urging tailored counselling and information to empower informed decisions.
Exploring Impulsivity Levels in Suicide Attempters with Varying Lethality
Authors: Kasapa Kalyan , Bale Sudhaker , Mohammed Rishi Raj , Sharanya J , Ch Vaishnavi
Published: August 2024

Background:

Impulsivity is a critical factor in understanding suicidal behavior, influencing the likelihood and lethality of suicide attempts. This study investigates the relationship between impulsivity levels and the lethality of suicide attempts, aiming to elucidate the role of impulsivity in suicidal actions and to inform targeted interventions.

Methodology:

A sample of 100 participants who had recently attempted suicide was categorized into two groups based on the lethality of their attempts: low lethality (n = 79) and high lethality (n = 21). Impulsivity levels were measured using the Barratt Impulsivity Scale-15 (BIS-15). Statistical analyses, including t-tests, were conducted to compare the mean impulsivity scores between the two groups.

Results:

The low lethality group had a mean BIS-15 score of 41.20 (standard deviation [SD] = 4.493), while the high lethality group had a mean score of 33.29 (SD = 7.254). The difference in mean scores was statistically significant (t = 6.228, P < 0.001), indicating higher impulsivity in the low lethality group. The SDs suggest greater variability in impulsivity levels within the high lethality group.

Conclusion:

The findings demonstrate a significant inverse relationship between impulsivity levels and the lethality of suicide attempts. Individuals with higher impulsivity tend to engage in less lethal suicide attempts, while those with lower impulsivity may plan more lethal attempts. These insights underscore the importance of assessing impulsivity in clinical settings to tailor prevention strategies and interventions effectively.
Physical Dependence on a Microdose of Opioid Substitution Therapy
Authors: Dabholkar Devina Devdatt , Chavhan Ravindra , Dakshikar Sarika
Published: August 2024

Buprenorphine is often used for opioid substitution therapy due to its safety profile and lack of psychological dependence. However, physical dependence on buprenorphine is a poorly studied concept with very little literature available. We, hereby, present our case of a 33-year-old male who developed physical dependence on a microdose of 0.4 mg buprenorphine – a dose that is not considered therapeutically significant. Some patients may need to be given these microdoses of buprenorphine long term to prevent relapse.
A Case Report of a Reversible Movement Disorder in an Elderly Male with Late-onset Psychosis
Authors: Bhat Abhay Keshava , Dakshikar Sarika , Meshram Sheetal Reshram , Fatima Javeriya
Published: August 2024

The approach to diagnosing and treating psychosis in the elderly is a complex challenge, especially in the setting of multiple comorbidities, and conflicting symptom domains. The patient described is an elderly male with diabetes, hypertension, and ischemic heart disease, with abnormal choreiform movements for 6 months, and psychotic symptoms for 2 months. Antipsychotics resulted in improvement of psychotic symptoms only. Neuroimaging revealed changes suggestive of nonketotic hyperglycemic hemichorea, which improved only with glycemic control. Balancing treatment with minimal impact on comorbidities is a delicate process to ensure correction of all possible reversible causes, as with this case.
Case Report of Onset of Mephentermine Use Disorder in a Middle-aged Female
Authors: Sawant Arhita , Sheth Megha , Jalak Prashant , Dakshikar Sarika
Published: August 2024

Following is a case report of a 41-year-old female who presented to the casualty of General Hospital, Psychiatry Unit of a Teaching Tertiary Care Institute with psychotic complaints. After the patient’s violent behavior was brought under control using injectable psychotropic medications in the casualty, patient’s relative disclosed a history of injection mephentermine sulfate intravenous use for the past 4 years. The patient was diagnosed with mephentermine use disorder with mephentermine-induced psychosis. She was treated for her psychosis, and motivation enhancement sessions were initiated at the hospital. Mephentermine sulfate use is increasing in the young male population of the country; however, the onset of substance use in a middle-aged female is rare. This case aims to highlight the importance of broadening the window for screening for substance use in the target populations.
Immunotherapy for gastric cancer and liver metastasis: Is it time to bid farewell
Authors: Dehal Ahmed
Published: August 2024

Patients with metastatic gastric cancer have a grim prognosis. Palliative chemotherapy offers a limited survival improvement, but recent advancements in immunotherapy have sparked hope. However, the effectiveness of immunotherapy in patients with liver metastases remains debated. This article reviews a recent study by Liu et al and evaluates conflicting evidence on the impact of liver metastases on response to immunotherapy in metastatic gastric cancer. While some studies suggest no significant difference in treatment response based on liver involvement, others report varied response rates. The present study, a retrospective analysis of 48 patients by Liu et al , examines this issue and concludes that immunotherapy is less effective in patients with liver metastases. Despite methodological limitations and a small sample size, the study contributes to the ongoing discourse. The nuanced response to immunotherapy in certain patients underscores the importance of understanding the tumor microenvironment, immune cell infiltration, and the expression of immune checkpoints. Rather than dismissing immunotherapy for patients with gastric cancer and liver metastases, a shift towards personalized treatment strategies and a more profound understanding of tumor-specific biomarkers is essential. By unraveling the molecular intricacies of individual cases, clinicians may tailor more effective and customized treatments, offering a glimmer of hope for this challenging patient group.
Role of endoscopic ultrasound-guided biliary drainage for palliation of malignant biliary obstruction
Authors: Singh Sahib , Chandan Saurabh , Facciorusso Antonio
Published: August 2024

Endoscopic ultrasound-guided biliary drainage (EUS-BD) directs bile flow into the digestive tract and has been mostly used in patients with malignant biliary obstruction (MBO) where endoscopic retrograde cholangiopancreatography-guided biliary drainage was unsuccessful or was not feasible. Lumen apposing metal stents (LAMS) are deployed during EUS-BD, with the newer electrocautery-enhanced LAMS reducing procedure time and complication rates due to the inbuilt cautery at the catheter tip. EUS-BD with electrocautery-enhanced LAMS has high technical and clinical success rates for palliation of MBO, with bleeding, cholangitis, and stent occlusion being the most common adverse events. Recent studies have even suggested comparable efficacy between EUS-BD and endoscopic retrograde cholangiopancreatography as the primary approach for distal MBO. In this editorial, we commented on the article by Peng et al published in the recent issue of the World Journal of Gastrointestinal Surgery in 2024.
Advancements in nutritional diagnosis and support strategies during the perioperative period for patients with liver cancer
Authors: Li Xiao-Qin , Liang Yun , Huang Chen-Feng , Li Sui-Ning , Cheng Lei , You Chuan , Liu Yao-Xia , Wang Tao
Published: August 2024

Liver cancer represents a grave hepatic condition and constitutes a significant global health concern. Surgical resection remains the principal therapeutic modality for liver cancer. Nevertheless, perioperative malnutrition exerts a notable impact on patients with liver cancer, emerging as an independent risk factor for disease mortality and adverse outcomes. Hence, precise nutritional diagnosis and timely nutritional support hold the potential to enhance therapeutic efficacy and quality of life for liver cancer patients. This study represents a meticulous foray into the literature, extracting data from PubMed, Web of Science, and Embase databases, with a focus on the past 5 years. It scrutinizes the impact of malnutrition on patients undergoing liver cancer surgery, the etiological underpinnings of malnutrition within this patient cohort, the critical assessment of perioperative nutritional status, and the strategic approaches to nutritional support. Utilizing rigorous inclusion and exclusion criteria, the amassed scholarly works are meticulously synthesized, methodically organized, and categorically elaborated upon. Ultimately, the authors propose the incorporation of a multidisciplinary nutrition management team during the perioperative period, comprising nutritionists, pharmacists, physicians, nurses, psychologists, and rehabilitation therapists, among other specialized professionals. Together, they collaborate to devise and implement personalized nutritional support plans, monitor patients’ nutritional status, and make necessary adjustments as required. Through comprehensive management and intervention, improvements in the nutritional status of liver cancer patients can be achieved, thereby enhancing surgical success rates and facilitating postoperative recovery. It is believed that this manuscript will offer valuable insights to advance the nutritional management during the perioperative phase of liver cancer, aiding in ameliorating patients' nutritional status and treatment outcomes.
Assessment of perianal fistulizing Crohn’s disease activity with endoanal ultrasound: A retrospective cohort study
Authors: Hong Na , Liu Wei-Yong , Zhang Jin-Long , Qian Kai , Liu Jie , Ye Xian-Jun , Zeng Fei-Yan , Yu Yue , Zhang Kai-Guang
Published: August 2024

BACKGROUND

Perianal fistulas pose dual challenges to Crohn's disease (CD) patients. Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.

AIM

To determine the accuracy of endoanal ultrasound (EUS) and shear wave elastography (SWE) for evaluating perianal fistulizing CD (PFCD) activity.

METHODS

This was a retrospective cohort study. A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups: Non-anal fistula group (n = 23), low-activity perianal fistulas [n = 19, perianal disease activity index (PDAI) ≤ 4], high-activity perianal fistulas (n = 25, PDAI > 4) based on the PDAI. All patients underwent assessments including EUS + SWE, pelvic magnetic resonance [pelvic magnetic resonance imaging (MRI)], C-reactive protein, fecal calprotectin, CD activity index, PDAI.

RESULTS

The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%, and there was good consistency in the classification of perianal fistulas (Kappa = 0.752, P < 0.001). Significant differences were observed in the blood flow Limberg score (χ 2 = 8.903, P < 0.05) and shear wave velocity (t = 2.467, P < 0.05) between group 2 and 3. Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD (Magnifi-CD) score (r = -0.676, P < 0.001), a weak negative correlation with the PDAI score (r = -0.386, P < 0.05), and a weak correlation between the Limberg score and the PDAI score (r = 0.368, P < 0.05).

CONCLUSION

EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients. It may be the ideal tool to assess PFCD activity objectively for management strategies.
Clinical significance of peripheral blood immune cells in patients with gastric cancer after surgery
Authors: Wang Qian-Wen , Zhu Jie-Wen , Gong Ling-Zhen
Published: August 2024

BACKGROUND

Gastric cancer is one of the most common malignant tumors worldwide, and surgical resection is one of the main ways to treat gastric cancer. However, the immune status of postoperative patients is crucial for prognosis and survival, and immune cells play an important role in this process. Therefore, it is helpful to understand the immune status of postoperative patients by evaluating the levels of peripheral blood immune cells, especially total T cells (CD3+), helper T cells (CD3+CD4+), and suppressor T cells (CD3+CD8+), and its relationship to survival.

AIM

To analyzed the immune cells in peripheral blood of patients with gastric cancer after surgery, detect the levels of total T cells, helper T cells and suppressor T cells.

METHODS

A total of 58 patients with gastric cancer who received surgical treatment were included in the retrospective study. Flow cytometry was used to detect the level of peripheral blood immune cells and analyze the correlation between total T cells, helper T cells and inhibitory T cells. To explore the relationship between these immune markers and patient survival.

RESULTS

The results showed that the levels of total T cells, helper T cells, and suppressor T cells changed in patients after gastric cancer surgery. There was a significant positive correlation between total T cells, helper T cells and suppressor T cells (r = 0.35, P < 0.01; r = 0.56, P < 0.01). However, there was a negative correlation between helper T cells and suppressor T cells (r = -0.63, P < 0.01). Follow-up showed that the survival rate of patients in the high-level total T cell group was significantly higher than that in the low-level group (28.87 ± 24.98 months vs 18.42 ± 16.21 months). The survival curve shows that the curve of patients in the high-level group is shifted to the upper right, and that of the low-level group is shifted downward. There was no significant difference between the levels of helper T cells and suppressor T cells and patient survival time.

CONCLUSION

By detecting peripheral blood immune cells with flow cytometry, we can initially evaluate the immune status of patients after gastric cancer surgery and initially explore its relationship with patient survival.
Lone-Star retractor perineal exposure method for laparoscopic abdominal perineal resection of rectal cancer
Authors: Ma Jun , Tang Dai-Bin , Tang Yu-Quan , Wang Da-Tian , Jiang Peng , Zhang Ya-Ming
Published: August 2024

BACKGROUND

The abdominal perineal resection (APR), historically referred to as Mile’s procedure, stands as a time-honored surgical intervention for rectal cancer management. Advancements in surgical techniques and the advent of neoadjuvant therapies have significantly improved the rate of sphincter preservation among patients afflicted with rectal cancer, including those with ultralow rectal cancer. Despite these improvements, APR maintains its irreplaceable role in the clinical landscape, particularly for cases involving low rectal cancer with encroachment on the external anal sphincter or levator ani muscles. Optimal perineal exposure stands as a pivotal phase in APR, given that the precision of this maneuver is directly correlated with both the safety of the surgery and the patient’s subsequent long-term prognosis.

AIM

To evaluate the value of Lone-Star retractor (LSR) perineal exposure method in the treatment for laparoscopic APR of rectal cancer.

METHODS

We reviewed the records of 38 patients with rectal cancer at Anqing Municipal Hospital from January 2020 to December 2023, including 20 patients who underwent the APR procedure with a LSR perineal exposure method (LSR group) and 18 patients who underwent the APR procedure with a conventional perineal exposure method (control group). In the LSR group, following incision of the skin and subcutaneous tissue, the LSR was placed and dynamically adjusted according to the surgical plane to fully expose the perineal operative field.

RESULTS

A total of 38 patients underwent laparoscopic APR, none of whom were found to have distant metastasis upon intraoperative exploration. Perineal blood loss, the postoperative hospital stays and the wound pain scores in the LSR group were significantly lower than those in the control group. A single surgeon completed the perineal operation significantly more often in the LSR group than in the control group (P < 0.05). The incidence of infection via the perineal incision in the LSR group was significantly lower than that in the control group (P < 0.05). No cases of distant metastasis or local recurrence were found among the patients at the postoperative follow-up.

CONCLUSION

The application of the LSR technique might be helpful for performing perineal exposure during APR for rectal cancer and could reduce the incidence of perineal complications, shorten the postoperative hospital stay, improve postoperative pain, and allow one surgeon to perform the perineal operation.
Preoperative prediction of hepatocellular carcinoma microvascular invasion based on magnetic resonance imaging feature extraction artificial neural network
Authors: Xu Jing-Yi , Yang Yu-Fan , Huang Zhong-Yue , Qian Xin-Ye , Meng Fan-Hua
Published: August 2024

BACKGROUND

Hepatocellular carcinoma (HCC) recurrence is highly correlated with increased mortality. Microvascular invasion (MVI) is indicative of aggressive tumor biology in HCC.

AIM

To construct an artificial neural network (ANN) capable of accurately predicting MVI presence in HCC using magnetic resonance imaging.

METHODS

This study included 255 patients with HCC with tumors < 3 cm. Radiologists annotated the tumors on the T1-weighted plain MR images. Subsequently, a three-layer ANN was constructed using image features as inputs to predict MVI status in patients with HCC. Postoperative pathological examination is considered the gold standard for determining MVI. Receiver operating characteristic analysis was used to evaluate the effectiveness of the algorithm.

RESULTS

Using the bagging strategy to vote for 50 classifier classification results, a prediction model yielded an area under the curve (AUC) of 0.79. Moreover, correlation analysis revealed that alpha-fetoprotein values and tumor volume were not significantly correlated with the occurrence of MVI, whereas tumor sphericity was significantly correlated with MVI (P < 0.01).

CONCLUSION

Analysis of variable correlations regarding MVI in tumors with diameters < 3 cm should prioritize tumor sphericity. The ANN model demonstrated strong predictive MVI for patients with HCC (AUC = 0.79).
Transmembrane serine protease 4 expression in the prognosis of radical resection for biliary tract cancer
Authors: Shibata Yoshiyuki , Sudo Takeshi , Tazuma Sho , Tanimine Naoki , Onoe Takashi , Shimizu Yosuke , Yamaguchi Atsushi , Kuraoka Kazuya , Takahashi Shinya , Tashiro Hirotaka
Published: August 2024

BACKGROUND

Recent advancements in biliary tract cancer (BTC) treatment have expanded beyond surgery to include adjuvant therapy, yet the prognosis remains poor. Identifying prognostic biomarkers could enhance the assessment of patients who have undergone radical resection for BTC.

AIM

To determine transmembrane serine protease 4 (TMPRSS4) utility as a prognostic biomarker of radical resection for BTC.

METHODS

Medical records of patients who underwent radical resection for BTC, excluding intrahepatic cholangiocarcinoma, were retrospectively reviewed. The associations between TMPRSS4 expression and clinicopathological factors, overall survival, and recurrence-free survival were analyzed.

RESULTS

Among the 85 patients undergoing radical resection for BTC, 46 (54%) were TMPRSS4-positive. The TMPRSS4-positive group exhibited significantly higher preoperative carbohydrate antigen 19-9 (CA19-9) values and greater lymphatic invasion than the TMPRSS4-negative group (P = 0.019 and 0.039, respectively). Postoperative overall survival and recurrence-free survival were significantly worse in the TMPRSS4-positive group (median survival time: 25.3 months vs not reached, P < 0.001; median survival time: 28.7 months vs not reached, P = 0.043, respectively). Multivariate overall survival analysis indicated TMPRSS4 positivity, pT3/T4, and resection status R1 were independently associated with poor prognosis (P = 0.032, 0.035 and 0.030, respectively). TMPRSS4 positivity correlated with preoperative CA19-9 values ≥ 37 U/mL and pathological tumor size ≥ 30 mm (P = 0.016 and 0.038, respectively).

CONCLUSION

TMPRSS4 is a potential prognostic biomarker of radical resection for BTC.
Efficiency and safety of laparoscopic left hemihepatectomy: A study of intrathecal vs extrathecal Glissonean pedicle techniques
Authors: Kang Li-Min , Xu Lei , Zhang Fu-Wei , Yu Fa-Kun , Lang Li
Published: August 2024

BACKGROUND

Selective hemihepatic vascular occlusion is utilized in both right and left hemihepatectomies to preserve blood supply to the intact lobe, maintain hemodynamic stability, and mitigate surgical risks. While this technique encompasses both intrathecal and extrathecal Glissonean pedicle transection methods, there is a lack of systematic comparative reports on these two approaches.

AIM

To retrospectively analyze the clinical data of patients with hepatocellular carcinoma (HCC) undergoing laparoscopic anatomical hepatectomy in our hospital to explore the feasibility, safety, and short- and long-term efficacy of extrathecal and intrathecal Glissonean pedicle transection methods in laparoscopic left hemihepatectomy.

METHODS

A retrospective study was performed to analyze the clinical data of 49 HCC patients who underwent laparoscopic left hemihepatectomy from January 2019 to December 2022 in our hospital. These patients were divided into extrathecal Glissonean pedicle transection (EGP) group (n = 24) and intrathecal Glissonean pedicle transection (IGP) group (n = 25) according to the different approaches used for selective hemihepatic vascular occlusion. The perioperative indicators, liver function indexes, complications, and follow-up findings were compared between these two groups.

RESULTS

The surgeries were smooth in both groups, and no perioperative death was noted. The hepatic pedicle transection time and the operation time were (16.1 ± 2.3) minutes and (129.6 ± 19.0) minutes, respectively, in the EGP group, which were significantly shorter than those in the IGP group [(25.5 ± 2.4) minutes and (184.8 ± 26.0) minutes, respectively], both P < 0.01. There were no significant differences in intraoperative blood loss, time to anal exhaust, hospital stay, drain indwelling time, and postoperative liver function between the two groups (all P > 0.05). The incidence of postoperative complications showed no significant difference [16.67% (4/24) vs 16.0% (4/25), P > 0.05). All the 49 HCC patients were followed up after surgery (range: 11.2-53.3 months; median: 36.4 months). The overall survival rate and disease-free survival rate were not significantly different (both P > 0.05).

CONCLUSION

Both extrathecal and intrathecal Glissonean pedicle approaches are effective and safe hepatic inflow occlusion techniques in laparoscopic left hemihepatectomy for HCC. However, the extrathecal approach simplifies the hepatic pedicle transection, shortens the operation time, and increases the surgical efficiency, making it a more feasible technique.
Innovative integration of lung ultrasound and wearable monitoring for predicting pulmonary complications in colorectal surgery: A prospective study
Authors: Lin Chen , Wang Pei-Pei , Wang Zi-Yan , Lan Guo-Ru , Xu Kai-Wen , Yu Chun-Hua , Wu Bin
Published: August 2024

BACKGROUND

Postoperative pulmonary complications (PPCs) are common in patients who undergo colorectal surgery. Studies have focused on how to accurately diagnose and reduce the incidence of PPCs. Lung ultrasound has been proven to be useful in preoperative monitoring and postoperative care after cardiopulmonary surgery. However, lung ultrasound has not been studied in abdominal surgeries and has not been used with wearable devices to evaluate the influence of postoperative ambulation on the incidence of PPCs.

AIM

To investigate the relationship between lung ultrasound scores, PPCs, and postoperative physical activity levels in patients who underwent colorectal surgery.

METHODS

In this prospective observational study conducted from November 1, 2019 to August 1, 2020, patients who underwent colorectal surgery underwent daily bedside ultrasonography from the day before surgery to postoperative day (POD) 5. Lung ultrasound scores and PPCs were recorded and analyzed to investigate their relationship. Pedometer bracelets measured the daily movement distance for 5 days post-surgery, and the correlation between postoperative activity levels and lung ultrasound scores was examined.

RESULTS

Thirteen cases of PPCs was observed in the cohort of 101 patients. The mean (standard deviation) peak lung ultrasound score was 5.32 (2.52). Patients with a lung ultrasound score of ≥ 6 constituted the high-risk group. High-risk lung ultrasound scores were associated with an increased incidence of PPCs after colorectal surgery (logistic regression coefficient, 1.715; odds ratio, 5.556). Postoperative movement distance was negatively associated with the lung ultrasound scores [Spearman’s rank correlation coefficient (r ), -0.356, P < 0.05].

CONCLUSION

Lung ultrasound effectively evaluates pulmonary condition post-colorectal surgery. Early ambulation and respiratory exercises in the initial two PODs will reduce PPCs and optimize postoperative care in patients undergoing colorectal surgery.
Effect of growth hormone on colonic anastomosis after intraperitoneal administration of 5-fluorouracil, bleomycin and cisplatin: An experimental study
Authors: Lambrou Ioannis , Mantzoros Ioannis , Ioannidis Orestis , Tatsis Dimitrios , Anestiadou Elissavet , Bisbinas Vasiliki , Pramateftakis Manousos-Georgios , Kotidis Efstathios , Driagka Barbara , Kerasidou Ourania , Symeonidis Savvas , Bitsianis Stefanos , Sifaki Freideriki , Angelopoulos Konstantinos , Demetriades Haralabos , Angelopoulos Stamatios
Published: August 2024

BACKGROUND

Growth hormone (GH) plays a crucial role in wound healing and tissue repair in postoperative patients. In particular, colonic anastomosis healing following colorectal surgery is impaired by numerous chemotherapy agents.

AIM

To investigate whether GH can improve the healing of a colonic anastomosis following the adverse effects of intraperitoneal administration of 5-fluorouracil (5-FU), bleomycin and cisplatin.

METHODS

Eighty Wistar rats underwent laparotomy and a 1 cm-resection of the transverse colon, followed by an end-to-end anastomosis under general anesthesia. The rats were blindly allocated into four equal groups and administered a different daily intraperitoneal therapeutic regimen for 6 days. The control group (A) received normal saline. Group B received chemotherapy with 5-FU (20 mg/kg), bleomycin (4 mg/kg) and cisplatin (0.7 mg/kg). Group C received GH (2 mg/kg), and group D received the aforementioned combination chemotherapy and GH, as described. The rats were sacrificed on the 7th postoperative day and the anastomoses were macroscopically and microscopically examined. Body weight, bursting pressure, hydroxyproline levels and inflammation markers were measured.

RESULTS

All rats survived until the day of sacrifice, with no infections or other complications. A decrease in the body weight of group D rats was observed, not statistically significant compared to group A (P = 1), but significantly different to groups C (P = 0.001) and B (P < 0.01). Anastomotic dehiscence rate was not statistically different between the groups. Bursting pressure was not significantly different between groups A and D (P = 1.0), whereas group B had a significantly lower bursting pressure compared to group D (P < 0.001). All groups had significantly more adhesions than group A. Hydroxyproline, as a measurement of collagen deposition, was significantly higher in group D compared to group B (P < 0.05), and higher, but not statistically significant, compared to group A. Significant changes in group D were recorded, compared to group A regarding inflammation (3.450 vs 2.900, P = 0.016) and fibroblast activity (2.75 vs 3.25, P = 0.021). Neoangiogenesis and collagen deposition were not significantly different between groups A and D. Collagen deposition was significantly increased in group D compared to group B (P < 0.001).

CONCLUSION

Intraperitoneal administration of chemotherapy has an adverse effect on the healing process of colonic anastomosis. However, GH can inhibit the deleterious effect of administered chemotherapy agents and induce colonic healing in rats.
Management of distal cholangiocarcinoma with arterial involvement: Systematic review and case series on the role of neoadjuvant therapy
Authors: Hall Lewis A , Loader Duncan , Gouveia Santiago , Burak Marta , Halle-Smith James , Labib Peter , Alarabiyat Moath , Marudanayagam Ravi , Dasari Bobby V , Roberts Keith J , Raza Syed S , Papamichail Michail , Bartlett David C , Sutcliffe Robert P , Chatzizacharias Nikolaos A
Published: August 2024

BACKGROUND

The use of neoadjuvant therapy (NAT) in distal cholangiocarcinoma (dCCA) with regional arterial or extensive venous involvement, is not widely accepted and evidence is sparse.

AIM

To synthesise evidence on NAT for dCCA and present the experience of a high-volume tertiary-centre managing dCCA with arterial involvement.

METHODS

A systematic review was performed according to PRISMA guidance to identify all studies reporting outcomes of patients with dCCA who received NAT. All patients from 2017 to 2022 who were referred for NAT for dCCA at our centre were retrospectively collected from a prospectively maintained database. Baseline characteristics, NAT type, progression to surgery and oncological outcomes were collected.

RESULTS

Twelve studies were included. The definition of “unresectable” locally advanced dCCA was heterogenous. Four studies reported outcomes for 9 patients who received NAT for dCCA with extensive vascular involvement. R0 resection rate ranged between 0 and 100% but without survival benefit in most cases. Remaining studies considered either NAT in resectable dCCA or inclusive with extrahepatic CCA. The presented case series includes 9 patients (median age 67, IQR 56-74 years, male:female 5:4) referred for NAT for borderline resectable or locally advanced disease. Three patients progressed to surgery and 2 were resected. One patient died at 14 months with evidence of recurrence at 6 months and the other died at 51 months following recurrence 6 months post-operatively.

CONCLUSION

Evidence for benefit of NAT is limited. Consensus on criteria for uniform definition of resectability for dCCA is required. We propose using the established National-Comprehensive-Cancer-Network® criteria for pancreatic ductal adenocarcinoma.
Global research landscape of Peutz-Jeghers syndrome and successful endoscopic management of intestinal intussusception in patients with recurrent laparotomies
Authors: Sun Qi , Wang Xiao-Ying , Guo Guang-Jin , Wang Lei , Meng Li-Min , Guo Yun-Fei , Sun Tao , Ning Shou-Bin
Published: August 2024

BACKGROUND

Peutz-Jeghers syndrome (PJS) has brought significant physical, psychological and economic burdens on the patients and their families due to its early onset, diagnostic and therapeutic challenges and increased recurrence risk.

AIM

To explore the current research status and emerging hotspots of PJS.

METHODS

Studies on PJS published during 1994-2023 were gathered based on Web of Science Core Collection. Additionally, a case of PJS-induced intestinal intussusception, successfully treated with endoscopic methods despite three laparotomies, was highlighted. Comprehensive bibliometric and visual analysis were conducted with VOSviewer, R and CiteSpace.

RESULTS

Altogether 1760 studies were identified, indicating a steady increase in the publication number. The United States had the highest influence, whereas the University of Helsinki emerged as the leading institution, and Aaltonen LA from the University of Helsinki was the most prolific author. Cancer Research, Oncogene and Endoscopy were the top three journals based on H-index. Keyword burst direction analysis revealed that "cancer risk", "management", "surveillance" and "familial pancreatic cancer" were the potential hotspots for investigation. Additionally, "early detection", "capsule endoscopy", "clinical management", "double-balloon endoscopy", "familial pancreatic cancer" and "molecular genetic basis" were identified as the key clusters of co-cited references. Endoscopic polypectomy remained effective on resolving intestinal intussusception in patients who underwent three previous laparotomies.

CONCLUSION

In the last three decades, global publications related to PJS show a steadily increasing trend in number. Endoscopic management is currently a research hotspot.
Hepatic recompensation according to the Baveno VII criteria via a transjugular intrahepatic portosystemic shunt: Is this true?
Authors: Zhang Jin-Shan
Published: August 2024

Hepatic recompensation is firstly described in the Baveno VII criteria, which requires the fulfillment of strict criteria. First, a primary cause of cirrhosis must be addressed, suppressed, or cured. Second, complications of liver cirrhosis, including ascites, encephalopathy, and variceal hemorrhage, must disappear without any intervention. Finally, liver function indicators must be improved. Moreover, without addressing/suppressing/curing cirrhosis and improvement in liver synthetic function, complications, including ascites and variceal hemorrhage can be improved by a transjugular intrahepatic portosystemic shunt (TIPS), which is not evidence of hepatic recompensation. Therefore, on the basis of the definition of hepatic recompensation, TIPS does not achieve hepatic recompensation.