bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inhibiting SHP2 reduces glycolysis, promotes microglial M1 polarization, and alleviates secondary inflammation following spinal cord injury in a mouse model
Authors: Ding Xintian , Chen Chun , Zhao Heng , Dai Bin , Ye Lei , Song Tao , Huang Shuai , Wang Jia , You Tao 
Published: May 2024

JOURNAL/nrgr/04.03/01300535-202503000-00030/figure1/v/2024-06-17T092413Z/r/image-tiffReducing the secondary inflammatory response, which is partly mediated by microglia, is a key focus in the treatment of spinal cord injury. Src homology 2-containing protein tyrosine phosphatase 2 (SHP2), encoded by PTPN11, is widely expressed in the human body and plays a role in inflammation through various mechanisms. Therefore, SHP2 is considered a potential target for the treatment of inflammation-related diseases. However, its role in secondary inflammation after spinal cord injury remains unclear. In this study, SHP2 was found to be abundantly expressed in microglia at the site of spinal cord injury. Inhibition of SHP2 expression using siRNA and SHP2 inhibitors attenuated the microglial inflammatory response in anin vitrolipopolysaccharide-induced model of inflammation. Notably, after treatment with SHP2 inhibitors, mice with spinal cord injury exhibited significantly improved hind limb locomotor function and reduced residual urine volume in the bladder. Subsequentin vitroexperiments showed that, in microglia stimulated with lipopolysaccharide, inhibiting SHP2 expression promoted M2 polarization and inhibited M1 polarization. Finally, a co-culture experiment was conducted to assess the effect of microglia treated with SHP2 inhibitors on neuronal cells. The results demonstrated that inflammatory factors produced by microglia promoted neuronal apoptosis, while inhibiting SHP2 expression mitigated these effects. Collectively, our findings suggest that SHP2 enhances secondary inflammation and neuronal damage subsequent to spinal cord injury by modulating microglial phenotype. Therefore, inhibiting SHP2 alleviates the inflammatory response in mice with spinal cord injury and promotes functional recovery postinjury.
Reconstruction of Hand and Wrist Soft-Tissue Defects using Radial Artery Perforator Flap
Authors: FEBOPRAS Alper Ural , Bilgen Fatma , Bekerecioğlu Mehmet 
Published: May 2024

Aim:
Soft-tissue defects in the hand and wrist are frequently encountered injuries that may occur due to trauma, burns, or other causes. We aimed to report our experiences in reconstruction of these defects using a radial artery perforator flap (RAPF).

Materials and Methods:
Eight patients who underwent surgery for reconstruction of the hand and wrist soft-tissue defects at our institution between December 2017 and December 2019 were included in the study. The patients were evaluated in terms of age, sex, etiology, flap size, defect region, and postoperative complications.

Results:
All defects were reconstructed by utilizing RAPF. The most common etiology of the defects was work-related accidents. The mean age of the patients was 40.4 (10–69) years. The mean flap size was 63.5 ± 14.76 cm2. Six patients healed uneventfully, while we observed partial necrosis of the RAPF flap in one of the cases and a marginal epidermolysis in another. The donor sites were skin grafted in each patient. The patient where partial necrosis observed was re-operated for debridement and skin grafting subsequentially. The duration of follow-up of the patients was 6 months.

Conclusions:
Radial forearm perforator flap is a reliable and effective reconstructive option to reconstruct small to moderately sized defects of the hand and wrist.
Determination of Facial Reanimation Patients Who can be Transferred Muscle after Crossfacial Nerve Graft
Authors: Majidov Nijat , Akdag Osman , Sutcu Mustafa , Tosun Zekeriya 
Published: May 2024

Aims:
The aim of facial reanimation isto restore facial symmetry in spontaneous, mimic, and emotional movements. One of the important reconstructive treatment options in patients with long-term facial paralysis is free muscle transfers. The first stage in two-stage muscle transfers is the cross facial nerve graft (CFNG). In this study, our aim is to investigate the importance of Tinel's sign and EMG in the selection of patients who have had CFNG due to long-term facial paralysis and who can undergo muscle transfer repair and investigate the effectiveness of these methods.

Patients and Methods:
Ten patients who underwent crossfacial nerve grafting for long-term facial nerve paralysis between 2012 and 2018 were prospectively included in the study.

Results:
No complications were observed during the operation and follow-up of the patients. The reliability of EMG is lower than the Tinel's sign when making a muscle transfer decision in patients who undergo CFNG.

Conclusions:
In conclusion, the etiology of facial paralysis (severity of injury in traumatic paralysis), age of patients, comorbid conditions, surgical experience, postoperative physical therapy process and patient compliance play an active role in providing reinnervation.
Utility of Short-Scar Incisions Mimicking Breast Augmentation Incisions Through Periareolar or Submammary Approach for a Better Aesthetic Outcome and Patient Satisfaction
Authors: Okumus Ayhan 
Published: May 2024

Purpose:
The purpose of the study is to evaluate the long-term aesthetic outcome of single-session nipple-sparing mastectomy (NSM) and immediate breast reconstruction operations performed using short-scar incisions mimicking breast augmentation incisions through periareolar or submammary approach.

Materials and Methods:
A total of 23 breast cancer patients (mean age: 32 years, range 21–44 years) who underwent single-session NSM and immediate breast reconstruction operations (bilateral in 9) performed through periareolar or submammary approach were included. Data on patient age, breast cancer characteristics, side of mastectomy and reconstruction, postoperative complications were retrieved from hospital records. Aesthetic outcome (by both patients and plastic surgeon), patient satisfaction (visual analog scale [VAS] scores), and psychological outcome (via body image scale) were evaluated after a median 4-year (range, 9 months–11 years) follow-up.

Results:
Majority of the patients identified that size of the breast (95.7%), shape of breast (95.7%), breast symmetry (95.7%), scars on the breast (100.0%), nipple-areola complex (100%), and overall aesthetic results (95.7%) fulfilled expectations very much. Physician evaluation also revealed that aesthetic outcome was excellent for majority of patients in terms of breast symmetry (80.7%), breast volume (95.7%), position of submammary fold (95.7%), and overall aesthetic result (95.7%) and all patients in terms of scar appearance on the breast (100.0%). Mean (standard deviation) VAS scores for patient satisfaction were 9.4 (0.8). Total body image scale indicated very good body image in terms of affective (e.g. feeling self-conscious), behavioral (e.g. difficulty in looking at the naked body), and cognitive (e.g. satisfaction with appearance) aspects in all patients.

Conclusion:
Our findings indicate the utility of short-scar (~4 cm) incisions mimicking breast augmentation incisions in a single-session NSM and immediate breast reconstruction as associated with a low-postoperative complication rate, an excellent aesthetic outcome and a very high patient satisfaction.
Retrospective review of patients with testicular torsion in a University Hospital in Bahrain
Authors: Alkooheji Ishaq M , Alabbasi Mohamed , Khashaba Shehab , Rafie Mohamed A M Ebrahim , Corbally Martin 
Published: May 2024

Introduction:
Testicular torsion is a surgical emergency that, with delayed treatment, may be associated with loss of the testis. It commonly presents with sudden onset testicular pain, vague lower abdominal pain, nausea, and vomiting. Management often requires emergent surgical scrotal exploration, detorsion, and fixation or removal of the affected testis.

Materials and Methods:
Retrospective review of all the patients in a hospital covering the Muharraq district in Bahrain presenting with testicular pain.

Results:
During the six-year period from 2015 to 2021, 48 patients with testicular torsion were managed, with a mean age of 18.4 (± 9.2) years. Most patients (54.7%) presented within 6 hours of the onset of symptoms. All 48 patients underwent a doppler ultrasound, which confirmed the presence of testicular torsion in 87.5% of patients, with a sensitivity of 87% and specificity of 98.5%. Fourteen patients had non-viable testis on surgical exploration, with an average age of 16.6 (± 6.8) years and took an average of 13 to 24 hours to present to the emergency department after the start of pain. Most patients underwent scrotal ultrasound 60 minutes from the presentation to the emergency department and surgical exploration within 120 to 179 minutes. The rate of testicular torsion in patients who underwent diagnostic ultrasound at 60 minutes or more from presentation was 40%, compared to an overall rate of 29%. All detected cases of testicular torsion, except for one case, underwent bilateral fixation of the testes. Of those patients who underwent contralateral fixation, none presented with contralateral torsion, supporting the recommendation of contralateral fixation.

Conclusion:
Patients underwent comprehensive assessment of their complaint and emergent surgical intervention, including an ultrasound that did not delay the surgical intervention. We agree that clinical judgment is the primary tool for assessment of patients with acute scrotum and an adjunct emergent ultrasound does not significantly cause delays. We concur with the current recommendations for contralateral fixation and prompt surgical management as the anatomical anomaly is present bilaterally.
Dilute povidone-iodine irrigation during percutaneous nephrolithotomy to reduce postoperative infective complications – Is there any benefit?
Authors: Kone Kalyanaram , Mallikarjun Naveen Thimiri , Philipraj Joseph 
Published: May 2024

Background and Objective:
Infectious complications following stone lithotripsy is a significant source of patient morbidity and mortality. Post percutaneous nephrolithotomy fever is reported in 37% of patients undergoing PCNL and sepsis is the most common cause of mortality following PCNL. Thus, there is an urgent need to tackle lithotripsy-associated bacteremia occurring intraoperatively, keeping in mind the threat of emerging global antibiotic resistance. The aim of our study was to study the efficacy of using intermittent 0.35% dilute Povidone-Iodine (PI) irrigation during PCNL in reducing postoperative infection rate.

Materials and Methods:
This is a prospective observational study done in 24 patients diagnosed with Staghorn and matrix calculi requiring PCNL. All patients were taken up for the procedure with sterile urine culture or after treating them with culture-specific antibiotic with initial positive urine culture. Intraoperative pelvic urine was sent for culture and sensitivity. 0.35% dilute PI irrigation was used intermittently during the procedure. Patients were monitored and assessed for signs of post-PCNL infection and PI-related side effects. The results were compared with similar group of patients with similar stone characteristics who underwent PCNL before adopting the dilute PI irrigation protocol (non-PI irrigation group).

Results:
Among 24 patients, 18 patients had partial or complete Staghorn and 6 had matrix calculi. Five patients with Staghorn and three patients with matrix calculi had positive renal pelvic urine culture. In the non-PI irrigation group, 19 patients had Staghorn stones and 5 had matrix calculi. Three patients with Staghorn and two patients with matrix calculi had positive renal pelvic urine culture. Three patients (12.5%) had postoperative fever in the dilute PI irrigation group, compared to 11 patients (45.8%) in the non-PI irrigation group. No patient had PI-related complications.

Conclusion:
Our prospective study highlights that the use of 0.35% dilute PI irrigation intermittently during PCNL reduces the postoperative infection rate significantly.
The prevalence and risk factors of upgrading of Gleason grade group between transrectal ultrasound prostate biopsy and prostatectomy specimens
Authors: Promsen Worapong , Siriboonrid Satit , Binsri Nattapong , Kanjanatarayon Sarayut , Wiriyabanditkul Weerayut , Jiraanankul Vittaya 
Published: May 2024

Background:
The risk stratification of prostate cancer using Gleason grade group (GG), serum prostate-specific antigen (PSA), and T staging has an important role for appropriate treatment. In fact, the GG of biopsy was not the same as the prostatectomy specimen. The upgrading of GG has a significant risk of delay treatment. The study aims to evaluate the concordance of GG between biopsy and prostatectomy specimens and the factors of upgrading GG.

Materials and Methods:
Retrospectively reviewed data from January 2010 to December 2019, 137 patients underwent prostate biopsy and followed by prostatectomy. Patients’ data include pathological reports, imaging reports, serum PSA, PSA density (PSAD), and free PSA were analyzed by univariate and multivariate analysis.

Results:
The concordance between the pathology was found in 54 specimens (39.4%) with the upgrading of GG in the prostatectomy was 57 specimens (41.6%). Furthermore, the downgrading was 26 specimens (18.9%). Serum PSA >10 ng/ml (P 0.003), PSAD >0.2 ng/ml/cm3 (P 0.002), free/total PSA ratio (P 0.003), margin positive for malignancy (P 0.033), and extraprostatic involvement (P 0.039) were significantly related with upgrading at the univariate analysis. Only a PSAD >0.2 (P 0.014) was found to be an independent factor that is predictive of upstaging in multivariate analysis.

Conclusions:
The prevalence of upgrading of GG from prostate biopsy to radical prostatectomy is as high as the other study. The factor that related to upstaging of GG was PSAD. Therefore, additional tools for biopsy were required to enhance the accurate diagnosis and staging of prostate cancer.
Influence of tumor size in the progression of venous tumor thrombus in renal cell carcinoma
Authors: Thangarasu Mathisekaran , Prakash J. Sanjay , Bafna Sandeep , Aarthy P. , Govindaswamy Thirumalai Ganesan , Venugopal Balaji , Sivaraman Ananthakrishnan , Jain Nitesh , Balakrishnan Arunkumar , Raghavan Deepak , Venkatraman Murali , Chandranathan M. , Paul Rajesh , Selvaraj Nivash , Ramakrishnan Balasubramaniam , Ragavan Narasimhan 
Published: May 2024

Objective:
The objective of the study is to describe the perioperative outcomes, disease-specific, and overall survival status in patients diagnosed with renal cell carcinoma with inferior vena cava (IVC) tumor thrombus.

Patients and Methods:
We did a retrospective analysis of all patients who underwent radical nephrectomy along with IVC thrombectomy from the year 2013 to 2020. Mayo’s classification was used to stratify the level of IVC thrombus. Demographic, perioperative, histopathology data, complications, and survival status were analyzed.

Results:
Total number of patients included in the study was 39, (Male: Female = 84.6%: 15.4%). Median age of patients was 58 (interquartile range [IQR] 50–63) years. Median size of renal tumor (in cms) was 9.5 (IQR 7.5–12), 8 (IQR 7–11.5), 8.5 (IQR 7–11.75), and 11 (IQR 9.5–11) (P = 0.998) in level 1,2,3, and 4 tumors, respectively. Clear cell variant was seen in 32 patients (82%) with R0 resection in 17 patients. Twelve patients (30.7%) had systemic metastasis on presentation. The overall mean survival time was 66.4 months with 95% confidence interval (CI) (52.4–80.5 months). Mean recurrence-free survival is 76 months with (63–90) CI of 95%. Mean survival in patients who presented with metastasis is 47 months with 95% CI (52.4–80.5). Perioperative mortality rate was 5.12% in this study.

Conclusion:
The tumor size does not have an influence on the progression of tumor thrombus into IVC. Significant difference in survival was observed between different levels of thrombus with high mortality in level four tumors.
Xanthogranulomatous pyelonephritis: Case series – Clinical, radiologic, therapeutic, and histological aspects
Authors: Pais João Sakuray , Rocha Mirelle Barbosa , Muglia Valdair Francisco , Chahud Fernando , Molina Carlos Augusto Fernandes , Ruellas Heitor Ramos , Tucci Silvio Junior 
Published: May 2024

Purpose:
Xanthogranulomatous pyelonephritis (XGP) is a chronic and severe infection of the kidney. We aimed to review the main clinical, imaging, and histological findings and to assess predictors of surgical complications or hospitalization >10 days (no deaths reported).

Materials and Methods:
We retrospectively searched all patients with XGP treated at our institution from 2005 to 2019, with 57 patients enrolled. Clinical data were retrieved by a single reader, computed tomographic (CT) examinations by two radiologists, and histopathological specimens by an experienced pathologist.

Results:
The patients’ mean age was 44.3 ± 16.2 years and 41 (71.9%) were female. The most common symptoms were flank/lumbar pain (89.5%), fever (43.9%), and recurrent urinary tract infection (43.9%). The mean time until the presumptive diagnosis was 365.1 days and the median hospitalization period was 11 days. Blood tests showed anemia (78.9%), leukocytosis (43.6%) with left shift (21.6%). Urinalysis showed hematuria (75.6%), bacteriuria (40.9%), and leukocytes (93.2%). Urine cultures showed Escherichia coli in 14.8%, Proteus mirabilis in 7.4%, while 59.3% were negative. Of 40 patients with CT examinations, 38 (95%) presented with hydronephrosis and perinephric inflammatory changes (PIC) and 22 (55%) with Bear Paw sign. PIC was the only independent predictor at multivariate analysis for surgical complications. For prolonged hospitalization, fever and PIC were independent predictors at univariate, but only fever at multivariate analysis.

Conclusions:
XGP is a worrisome condition, with unclear pathophysiological mechanisms. Fever and PIC at CT examinations were predictors of poor outcomes.
Factors related to upstaging of clinical stage T2 organ-confined bladder cancer following radical cystectomy
Authors: El-Adawy Mahmoud Shoukry , Ibrahim Hisham , Zanaty Fouad , Kotb Sameh 
Published: May 2024

Aims:
This study aimed to detect possible risk factors related to upstaging of clinical stage T2 organ-confined (OC) to non-OC (nOC) bladder cancer (BC) following radical cystectomy (RC).

Settings and Design:
This was a prospective multicenter study.

Subjects and Methods:
This is a multicenter prospective study including 196 Egyptian BC patients undergoing RC from January 2017 to February 2019 at Cairo University, Fayoum University, and Menoufia University. Only patients with muscle invasive BC (T2) were included in the study. Patients’ characteristics, preoperative clinical data (including Hydronephrosis), cystoscopy data, and biopsy pathological data were recorded. Preoperative clinical staging is compared to postoperative pathological staging, to determine upstaged cases. The occurrence of upstaging in correspondence to each preoperative factor is recorded and statistically analyzed.

Results:
Among 196 BC patients of our study, upstaging from OC T2 to nOC occurred in 88 (44.9%) patients. Statistical analysis showed that the factors related to upstaging are older age (P ≤ 0.001), large tumor size (P = 0.048), lymphovascular invasion (LVI) (P ≤ 0.001), and multifocal tumor (P ≤ 0.001). On the other hand, the following factors were not related to upstaging: gender (P = 0.159), smoking (P = 0.286), preoperative hydronephrosis (P = 0.242), and presence of carcinoma in situ (P = 0.349).

Conclusions:
The difference between clinical and pathological staging of BC patients following RC is a frequent problem with no clear guidelines to overcome it. Several factors including age of the patient, large tumor size, LVI, and multifocal tumor are predictors of upstaging in OC BC. A good concern must be taken in these patients to achieve an optimum treatment plan for them.
Surgical management of stricture urethra in patients with chronic renal failure: Ten years’ experience at a tertiary center
Authors: Pathak Himadri , Purkait Bimalesh , Hameed Shahid , Das Anjan Kumar , Sarkar Kaushik , Ghoshal Prithwiraj 
Published: May 2024

Introduction:
Patients suffering from stricture urethra and deranged renal function have poor quality of life. The incidence of urethral stricture co-existing with renal failure is comparatively small and cause may be multifactorial. There is paucity of literature on management of urethral stricture associated with deranged renal function. We present our experience of managing stricture urethra associated with chronic renal failure.

Materials and Methods:
This was a retrospective study conducted from 2010 to 2019. Patients with stricture urethra and deranged renal function (serum creatinine >1.5 mg/dl) who underwent urethroplasty or perineal urethrostomy were included in our study. A total of 47 patients met the inclusion criteria and were included in this study. Patients were followed every 3 months in their 1st year of surgery and 6 monthly thereafter. Statistical analysis was done using SPSS version 16.

Results:
There was a significant increase in the mean postopérative maximum and average urinary flow rates when compared to the preoperative values. The overall success rate was 76.59%. Out of 47 patients, 10 had wound infection and delayed wound healing, 2 patients developed ventricular arrhythmias, 6 patients developed fluid and electrolyte imbalance, 2 patients developed seizures, and 1 patient developed septicemia in the postoperative period.

Conclusion:
Prevalence of patients with chronic renal failure associated with stricture urethra was 4.58% and features suggestive of deranged renal function at presentation were present in 1.81% patients. In the present study, complications related with chronic renal failure occurred in 17 (36.17%) patients. Multidisciplinary care of the patient along with appropriate surgical management is a viable option in this sub-group of patients.