bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Influence of Trabectome Surgery on Corneal Endothelial Cells
Authors: Kasahara Masayuki , Shoji Nobuyuki , Matsumura Kazuhiro 
Published: November 2018

Purpose:
The purpose of this study was to evaluate the influence of trabectome surgery on corneal endothelial cells by site.

Methods:
Retrospective observational study. Trabectome surgeries were performed on 159 eyes of 132 adult Japanese patients. Corneal endothelial cells were measured at the center (C), inferior (I), nasal inferior (NI), nasal superior (NS), superior (S), temporal superior (TS), and temporal inferior (TI) sectors at <1 month preoperatively and 3, 6, 12, 24, and 36 months postoperatively, for changes in corneal endothelial cell density (ECD), coefficient of variation (CV), and incidence of hexagonal cells (6A).

Results:
Mean preoperative ECD in all groups were 2401±451 (SD)  cells/mm2 (C), 2366±450 cells/mm2 (I), 2397±479 cells/mm2 (NI), 2476±554 cells/mm2 (NS), 2493±596 cells/mm2 (S), 2464±558 cells/mm2 (TS), and 2329±510 cells/mm2 (TI). The 12-month postoperative mean ECDs were 2344±480 cells/mm2 (C), 2312±469 cells/mm2 (I), 2325±536 cells/mm2 (NI), 2473±517 cells/mm2 (NS), 2438±607 cells/mm2 (S), 2227±578 cells/mm2 (TS), and 2193±523 cells/mm2 (TI). There was no change in ECD in all sectors before and after surgery. ECD decreased at the TS and TI in combination with cataract surgery (2620±430 and 2445±384 cells/mm2) preoperatively to 2264±501 and 2216±477 cells/mm2 at 12 months postoperatively. CV and 6A did not change at all sites in all surgical procedures before and after surgery.

Conclusions:
Trabectome surgery involves minimal effects to corneal endothelial cells, although long-term prospective studies with greater sample sizes are necessary to confirm this conclusion.
Minimally Invasive Ozaki Procedure in Aortic Valve Disease
Authors: Nguyen Dinh H. , Vo Anh T. , Le Khoi M. , Vu Thanh T. , Nguyen Trang T. , Vu Thien T. , Pham Chuong V. T. , Truong Binh Q. 
Published: November 2018

Objective The Ozaki procedure for aortic valve reconstruction was reported in 2014 with low mortality, a highly reproducible rate and a good midterm result. However, the procedure still requires conventional sternotomy to be accomplished. The aim of the study was to start an initial evaluation for the feasibility of the minimally invasive approach in combination with the Ozaki technique. Methods From January 06, 2017, to January 12, 2017, nine patients with severe aortic valve diseases underwent minimally invasive Ozaki procedure through an upper ministernotomy. The pericardium was harvested endoscopically using three trocars in different intercostal spaces. Then, a ministernotomy was performed and the Ozaki procedure was accomplished in a similar manner to the conventional technique. We analyzed the in-hospital mortality and complications of this group. Results The mean age was 47.4 years and 55.6% patients were female. The predominant pathology was chronic rheumatic valve disease (66.7%) and other patients were diagnosed with a bicuspid aortic valve. The mean aortic cross-clamp time was 106.8 minutes, the mean cardiopulmonary bypass time was 153.6 minutes, the mean ventilation time was 8.4 hours, and the mean intensive care unit time was 1.6 days. No mortality was recorded in our series, no conversion to full sternotomy was required, one patient experienced right hemothorax requiring drainage, and one patient required valve replacement. Intraoperative transesophageal echocardiography and predischarge transthoracic echocardiography showed five competent valves and three valves with trivial regurgitation, and no stenosis was detected. Conclusions Ministernotomy combined with Ozaki procedure might be feasible, as well as an alternative to conventional sternotomy. This approach is associated with low mortality and morbidity and may be beneficial in younger populations.
Robotic versus Video-Assisted Thoracoscopic Surgery Pulmonary Segmentectomy
Authors: Musgrove Kelsey A. , Hayanga Jeremiah A. , Holmes Sari D. , Leung Alexander , Abbas Ghulam 
Published: November 2018

Objective Pulmonary segmentectomy using robotic assistance is often perceived as being more expensive than segmentectomy using video-assisted thoracic surgery. The robotic technique allows for meticulous dissection during segmentectomy, potentially leading to fewer parenchymal injuries, fewer air leaks, and shorter length of stay. This study compared pulmonary segmentectomy costs using video-assisted thoracic surgery versus robotic with manual staplers versus robotic with robotic staplers. Methods Retrospective analyses were performed evaluating our early experience with robotic pulmonary segmentectomy for 30 months compared with the video-assisted thoracic surgery approach. All 50 anatomical segmentectomies performed since introduction of robotic technique in the practice were included. Twenty-eight procedures were robotic-assisted and 22 were video-assisted thoracic surgery. Procedure-specific evaluation of direct costs was performed, including cost of robotic instruments, staplers, and average length of stay in the hospital. Results The mean ± SD age was 70 ± 10 years (range = 43–91 years). There were 12 males in the robotic group and eight in the video-assisted thoracic surgery group ( P = 0.642). The mean age was 69 years in the robotic group and 71 years in the video-assisted thoracic surgery group ( P = 0.367). The median length of stay was 2 (2–4) days in the robotic group (range = 1–9) and 4 (2–5) days in the video-assisted thoracic surgery group (range = 1–20, P = 0.089). The cost of robotic segmentectomy with manual staplers was less than that with robotic staplers. Both robotic techniques cost less than video-assisted thoracic surgery. Conclusions In this small series, cost and outcomes in our early experience with robotic-assisted segmentectomy were comparable with our video-assisted thoracic surgery approach with trends toward shorter length of stay and fewer complications. Larger series are needed to validate these results.
Influence of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy
Authors: Zhang Juyi , Wang Yubin , Xu Hao , Yang Juan 
Published: November 2018

Abstract

Background:
The impact of magnesium sulfate on hemodynamic responses during laparoscopic cholecystectomy remains controversial. We conduct a systematic review and meta-analysis to explore the influence of magnesium sulfate on hemodynamic responses for laparoscopic cholecystectomy.

Methods:
We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through June 2018 for randomized controlled trials (RCTs) assessing the effect of magnesium sulfate on hemodynamic responses for laparoscopic cholecystectomy. Meta-analysis is performed using the random-effect model.

Results:
Four RCTs involving 208 patients are included in the meta-analysis. Overall, compared with control group in laparoscopic cholecystectomy, intravenous magnesium sulfate is associated with systolic blood pressure at 30 minutes [Std. MD = −1.34; 95% confidence interval (95% CI) = −1.86 to −0.82; P < .00001], diastolic blood pressure at 30 minutes (Std. MD = −1.40; 95% CI = −1.86 to −0.94; P < .00001), mean arterial pressure at 30 minutes (Std. MD = −1.19; 95% CI = −1.91 to −0.46; P = .001), systolic blood pressure at 10 minutes (Std. MD = −1.61; 95% CI = −2.08 to −1.13; P < .00001), diastolic blood pressure at 10 minutes (Std. MD = −1.54; 95% CI = −2.68 to −0.40; P = .008), heart rate at 30 minutes (Std. MD = −2.09; 95% CI = −2.87 to −1.32; P < .00001), but results in prolonged extubation time (Std. MD = 0.96; 95% CI = 0.18–1.74; P = .02).

Conclusion:
Magnesium sulfate can reduce blood pressure, but with the increase in extubation time for laparoscopic cholecystectomy.
Congenital anal atresia with rectovestibular fistula, scoliosis, unilateral renal agenesis, and finger defect (VACTERL association) in a patient with partial bicornuate uterus and distal vaginal atresia
Authors: Kang Jia , Mao Meng , Zhang Ye , Ai Fang-Fang , Zhu Lan 
Published: November 2018

Abstract

Rationale:
Vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect (VACTERL) association and Müllerian duct anomalies are rare conditions. We present a rare condition with the co-occurrence of the VACTERL association and Müllerian duct hypoplasia to characterize patients’ clinical presentations, outcomes, and treatment.

Patient concerns:
An 11-year-old girl presented to our hospital with severe lower abdominal pain, lower vaginal atresia with enlargement of the upper vagina and a bicornuate uterus with a Y-shaped uterine cavity filled with hematometra on pelvic magnetic resonance imaging. Her medical history included congenital anal atresia with a rectovestibular fistula, congenital right renal deficiency, congenital right thumb malformation, and scoliosis.

Diagnoses:
1. Congenital genital tract malformations, a partial bicornuate uterus, and distal vaginal atresia (U3aC0V4); 2. VACTERL association (congenital anal atresia with rectovestibular fistula, scoliosis with hemi vertebra and butterfly vertebra, unilateral renal agenesis, and finger defect).

Interventions:
Colpotomy, laparoscopic exploration, pelvic adhesiolysis, and hysteroscopy were performed.

Outcomes:
Two months after surgery, a pelvic examination showed an unobstructed vagina which was 10 cm long and 2 fingers wide, without adhesion or constriction.

Lessons:
Clinicians should have a high index of suspicion when evaluating patients with genital malformations associated with VACTERL. Early diagnosis of distal vaginal atresia with appropriate surgical intervention decreases long-term morbidity.
Learning curves for robotic pancreatic surgery-from distal pancreatectomy to pancreaticoduodenectomy
Authors: Shyr Bor-Uei , Chen Shih-Chin , Shyr Yi-Ming , Wang Shin-E. 
Published: November 2018

Abstract
This study sought to identify the learning curves of console time (CT) for robotic pancreaticoduodenectomy (RPD) and robotic distal pancreatectomy (RDP). Perioperative outcomes were compared between the early group of surgeries performed early in the learning curve and the late group of surgeries performed after the learning curve.
Pancreaticoduodenectomy (PD) is a technically demanding and challenging procedure carrying a high morbidity.
Data for RDP and RPD were prospectively collected for analysis. The learning curve was assessed by cumulative sum (CUSUM). Based on CUSUM analyses, patients were divided into the early group and the late group.
There were 70 RDP and 61 RPD cases. It required 37 cases to overcome the learning curve for RDP and 20 cases for RPD. The median console time was significantly shorter in the late group for both RDP (112 minutes vs 225 minutes, P < .001) and RPD (360 minuntes vs 520 minutes, P < .001). Median blood loss was significantly less in the late group for both RDP (30 cc vs 100 cc, P = .003) and RPD (100 cc vs 200 cc, P < .001). No surgical mortality occurred in either group. Clinically relevant pancreatic fistula rate was 22.9% for RDP (32.4% in the early group vs 12.1% in the late group, P = .043), and 11.5% for RPD (0 in early group vs 17.1% in late group, P = .084).
This study demonstrates that the RPD learning curve is 20 cases with prior experience of RDP and confirms the safety and feasibility of both RPD and RDP. Practice and familiarity with the robotic platform are likely to contribute to significant shortening of the learning curve in robotic pancreatic surgery, while knowledge and experience, in addition to practical skills, are also essential to minimize the potential surgical risks of RPD.
Propranolol eye drops in patients with corneal neovascularization
Authors: Filippi Luca , de Libero Cinzia , Zamma Gallarati Barbara , Fortunato Pina , Piozzi Elena 
Published: November 2018

Abstract

Rationale:
Studies performed in animal models of corneal neovascularization suggested the possible efficacy of a treatment with propranolol. Corneal neovascularization is one of the most feared complications of Stevens–Johnson syndrome that frequently involves ocular surface. We report the first 2 patients with severe ocular neo-vascularization treated with different degrees of success, with propranolol eye drops.

Patient concerns:
Two patients with corneal neovascularization complicating the Stevens–Johnson syndrome, not responsive to steroids and cyclosporine, were treated with propranolol eye drops.

Diagnoses:
Corneal neovascularization was detected by ophthalmoscopic evaluation.

Interventions:
Topical treatment with propranolol eye drops at different concentrations.

Outcomes:
Both patients reported dramatic subjective benefits (reduction of photophobia and discomfort) without adverse effects, and in the patient with a less advanced disease, an objective reduction of neovascularization and an improved visual acuity was observed.

Lessons:
This experience suggests that propranolol might be an inexpensive, safe and effective treatment in counteracting the progression of corneal neovascularization.
Spontaneous complete regression of large uterine fibroid after the second vaginal delivery
Authors: Kim Myounghwan 
Published: November 2018

Abstract

Rationale:
Fibroids are common, hormone-dependent, benign uterine tumors. It is estimated that they occur in 20% to 40% of women during their reproductive years. The prevalence of fibroids among pregnant women is 10.7%. Most fibroids do not increase in size during pregnancy. Pregnancy has a variable and unpredictable effect on fibroid growth. The influence of pregnancy on uterine fibroid size still remains unclear. Researchers evaluating fibroids have reported an inverse association between parity and fibroids, suggestive of a protective effect. Pregnancies that occur while fibroids are small would be protective; whereas pregnancies occurring before fibroid development or after the tumors reach some critical size would not be protective. Herein, the case of a woman with a large uterine fibroid that was spontaneously regressed after a second successful vaginal delivery is reported. To our knowledge, the complete regression of a large fibroid after delivery has not yet been reported.

Patient concerns:
A 35-year-old gravida 1 para 0 woman was referred from a private clinic with a history of pelvic mass, adnexal mass and 19 weeks of amenorrhea.

Diagnosis:
Ultrasonographic examination indicated a solid mass at the uterine fundus (12.1 × 8.3 cm) suggestive of a uterine fibroid and complex echogenic mass at the right adnexa (7.7 × 6.0 cm).

Interventions:
Usually, cesarean sections are performed after myomectomy due to the risk for rupture when attempting vaginal delivery. So, the patient decided against the myomectomy, because she did not have any myoma-related symptoms after the first vaginal delivery and wanted to have more children via vaginal birth.

Outcomes:
Six months postpartum she becomes pregnant again. The patient had another vaginal birth. Four years after second delivery, the large myoma completely regressed.

Lessons:
Fibroids can regress with postpartum involution. Even though fibroid-related pregnancy complication is 10% to 30%, prophylactic myomectomy is not recommended. In addition, given the protective effect of parity, conception and delivery are reasonable option and could allow treatment to be deferred in women planning a pregnancy.
Goal-directed fluid therapy does not reduce postoperative ileus in gastrointestinal surgery
Authors: Zhang Xiongxin , Zheng Wei , Chen Chaoqin , Kang Xianhui , Zheng Yueying , Bao Fangping , Gan Shuyuan , Zhu Shengmei 
Published: November 2018

Abstract

Background:
Perioperative goal-directed fluid therapy (GDFT) aiming to maintain individual fluid balance based on sensitive parameters was prevalent in major surgery, especially in enhanced recovery after surgery (ERAS) pathway. This meta-analysis was conducted for the purpose of evaluating whether GDFT impacts on occurrence of postoperative ileus and whether its application is worthwhile in gastrointestinal surgery.

Methods:
A systematic search of RCTs compared GDFT with other fluid management in patients undergoing gastrointestinal surgery from the PubMed, Web of Science, Embase, Cochrane Library databases was implemented. The primary outcome is incidence of postoperative ileus. Other outcome measures were length of hospital stay (LOS), postoperative morbidity and mortality. Subgroup analysis was planed a prior to verify the definite role of GDFT.

Results:
12 trials consisted of 1836 patients were included in the final analysis. GDFT did not influence the occurrence of postoperative ileus (relative risk, RR 0.71, 95% confidence interval, CI 0.47–1.07, P = .10), with moderate heterogeneity (I

2
= 29%, P = .16). No difference was found between GDFT and control groups in LOS (mean difference –0.17 days, 95% CI –0.73 to 0.39, P = .55), total complication rate (RR 0.92, 95% CI 0.81–1.05, P = .23), and 30-day mortality (RR 0.91, 95% CI 0.47–1.75, P = .77). In other secondary outcomes, only wound infection rate was lower in the GDFT group (RR 0.68, 95% CI 0.50–0.93, P = .02). When performed subgroup analysis, GDFT was superior in reduction ileus only when compared with standard therapy or in those outside ERAS.

Conclusions:
It is possible that GDFT dose not affect the occurrence of postoperative ileus in gastrointestinal surgery. It scarcely influences postoperative morbidity and mortality as well. However, lower incidence of ileus is observed in GDFT group either outside ERAS or compared with standard fluid therapy. Probably, GDFT may not be necessary in the ERAS pathway or if a hybrid approach is adopted.
Long-term safety and immunogenicity of the M72/AS01E candidate tuberculosis vaccine in HIV-positive and -negative Indian adults
Authors: Kumarasamy Nagalingeswaran , Poongulali Selvamuthu , Beulah Faith Esther , Akite Elaine Jacqueline , Ayuk Leo Njock , Bollaerts Anne , Demoitié Marie-Ange , Jongert Erik , Ofori-Anyinam Opokua , Van Der Meeren Olivier 
Published: November 2018

Abstract

Objectives:
To assess the long-term safety and immunogenicity of the M72/ Adjuvant System (AS01E) candidate tuberculosis (TB) vaccine up to 3 years post-dose 2 (Y3) in human immunodeficiency virus (HIV)-positive (HIV+) and HIV-negative (HIV−) Indian adults.

Methods:
This phase II, double-blind, randomised, controlled clinical trial (NCT01262976) was conducted at YRG CARE Medical Centre, in Chennai, India, between January 2011 and June 2015.
Three cohorts (HIV+ participants stable on antiretroviral therapy [ART; HIV+ART+], HIV+ ART-naïve [HIV+ART-], and HIV− participants) were randomised (1:1) to receive 2 doses of M72/AS01E (M72/AS01E groups) or saline (control groups) 1 month apart and were followed up toY3. Latent TB infection was assessed at screening using an interferon-gamma (IFN-γ) release assay (IGRA). Safety and immunogenicity results up to Y1 post-vaccination were reported elsewhere. Here, we report serious adverse events (SAEs), humoral and cell-mediated immune (CMI) responses to M72 recorded at Y2 and Y3.

Results:
Of 240 enrolled and vaccinated participants, 214 completed the long-term follow-up part of the study.
In addition to SAEs previously described, between Y1 and Y2 1 M72/AS01E recipient in the HIV+ART+ cohort reported 2 SAEs (sinus cavernous thrombosis and gastroenteritis) that were not considered as causally related to the study vaccine.
Vaccination elicited persistent humoral immune responses against M72. At Y3, seropositivity rates were 97.1%, 66.7%, and 97.3% and geometric mean concentrations (GMCs) were 22.0  ELISA units (EU)/mL, 4.9 EU/mL, and 24.3 EU/mL in the HIV+ART+, HIV+ART-, and HIV− cohorts, respectively. Humoral immune response was lowest in the HIV+ART- cohort.
In M72/AS01E recipients, no notable decrease in the frequency of M72-specific CD4+ T-cells expressing ≥2 immune markers among interleukin-2 (IL-2), IFN-γ, tumour necrosis factor alpha (TNF-α) and CD40 ligand (CD40L) was observed at Y3 post-vaccination. Median values (interquartile range) of 0.35% (0.13–0.49), 0.05% (0.01–0.10), and 0.15% (0.09–0.22) were recorded in the HIV+ART+, HIV+ART- and HIV− cohorts, respectively. CD4+ T-cell response was lowest in the HIV+ART- cohort.
No CD8+ T-cell response was observed.

Conclusion:
The cellular and humoral immune responses induced by M72/AS01E in HIV+ and HIV− adults persisted up to Y3 post-vaccination. No safety concerns were raised regarding administration of M72/AS01E to HIV+ adults.

Clinical Trial Registration:
NCT01262976 (www.clinicaltrials.gov).
Prognostic value of the systematic immune-inflammation index among patients with operable colon cancer
Authors: Tao Ming-Yue , Wang Zhong-Hong , Zhang Meng-Hui , Ma Tian-Heng , Yang Xiao-Zhong , Wu Shang-Nong , Chen Xiao-Fei , Wang Hong-Gang 
Published: November 2018

Abstract
The systematic immune-inflammation index (SII) has been used to predict the prognosis of patients with various cancers. This study aimed to determine whether the preoperative SII was associated with postoperative survival among patients with operable colon cancer.
This retrospective study included 118 age- and sex-matched healthy subjects and 118 patients who underwent radical surgery for colon cancer between January 2011 and December 2013. The preoperative SII was calculated based on counts of neutrophils, lymphocytes, and platelets in the peripheral blood. Pearson correlation analysis was used to analyze the relationships between the SII and carcinoembryonic antigen (CEA) concentration, average length of stay (ALOS), and medical costs during hospitalization. The χ2 test or Fisher exact test was used to analyze the relationship between the preoperative SII and the postoperative survival rate.
The median SII value was 667.75 among patients with colon cancer, which was higher than the value among healthy subjects. A high SII (>667.75) was associated with a large tumor size and advanced TNM stage, although it was not associated with age, sex, tumor location, or pathological grade. Pearson correlation analysis revealed that the SII was positively correlated with serum CEA concentration, ALOS, and medical costs. Relative to a low SII, a high SII was significantly associated with a lower overall survival rate at 3 years and 5 years after surgery.
The present study's findings suggest that the preoperative SII is a useful prognostic index for patients with operative colon cancer.