Hasil untuk "Surgery"

Celina DeBiasio, Jillian Dhawan, Quentin Nakonechny et al.

Leiomyosarcoma (LMS) of the skin is a rare malignant neoplasm that can have varied clinical presentations, even mimicking benign lesions, making diagnosis challenging. We describe a 74-year-old male with a history of subcutaneous LMS of the left leg treated successfully with surgery, chemotherapy, and radiation over 10 years prior, who presented with an incidental papule on the lower back resembling an accessory nipple. Biopsy revealed a spindle cell tumour with diffuse smooth muscle actin and desmin positivity and a high Ki-67 index, consistent with a non-metastatic subcutaneous LMS. Wide local excision confirmed dermal and subcutaneous involvement with negative margins. This case is notable for the occurrence of two distinct primary LMS lesions more than a decade apart, underscoring the importance of long-term surveillance in high-risk patients. Given the potential for recurrence or metastasis, careful histopathologic evaluation and ongoing monitoring remain critical in the management of LMS.

Julio Sedeño, Salvador Ruiz, Germán Martín et al.

The Lidia cattle breed is featured in several traditional popular bullfighting festivals throughout Spain, including the “Toro de Cuerda” event, in which the animals are subjected to intense physical exercise. However, the physiological impact and welfare implications of these activities remain poorly characterized. This study aimed to evaluate the stress response and muscle damage in Lidia breed bulls during roping bull celebrations through comprehensive blood analysis. Blood samples were collected from 53 adult male Lidia bulls before and after a standardized 45 min continuous running exercise during traditional roping bull events in four Spanish autonomous regions. Hematological parameters, muscle enzymes (creatine kinase, lactate dehydrogenase, lactate), and stress hormones (cortisol and ACTH) were analyzed. Significant increases (<i>p</i> < 0.05) were observed in leukocytes, lymphocytes, monocytes, eosinophils, neutrophils, erythrocytes, hematocrit, hemoglobin, and post-exercise platelets. Muscle enzymes showed marked elevations, with creatine kinase increasing up to 10-fold above baseline values. Stress hormones, cortisol and ACTH, also demonstrated significant increases. Despite the magnitude of these changes, all parameters remained within established reference ranges for the bovine species. This study provides the first physiological assessment of Lidia cattle during popular bullfighting celebrations, establishing baseline data for evidence-based welfare evaluation and management protocols.

Pankaj Garg, Mostafa Ali, Mohammad Alomari et al.

Abstract Cardiac benign metastatic leiomyoma (BML) is a rare cardiac tumor that is usually asymptomatic, frequently misdiagnosed and may result in serious complications, including embolization, heart failure and death. This review highlights the importance of considering cardiac BML in the differential diagnosis of cardiac masses, especially in women with a history of uterine leiomyomas. This review summarizes the current knowledge about cardiac BML, including its demographics, clinical presentation, etio-pathogenesis, diagnosis, and management. The authors discuss the challenges associated with diagnosing cardiac BML and emphasize the importance of a thorough history, physical examination, and imaging studies. They also review the different treatment options for cardiac BML, including surgical resection and role of medical and surgical castration. Early diagnosis and management of cardiac BML is crucial to prevent complications. This review provides valuable insights for clinicians who may encounter this rare condition. By raising awareness of cardiac BML and its management strategies, this review can improve patient care and outcomes.

Kehinde Peter Animasahun, Racheal Toluse Omoniyi, Taiwo Racheal Adeloye et al.

To determine the occurrence and causes of missed nursing care (MNC) among nurses in Nigeria. This was a hospital-based cross-sectional study done among nurses working in a hospital in Nigeria from August to November 2024. Sixty-two nurses were selected using the convenience sampling technique. Data was collected through self-administered MISSCARE survey tools. Pearson correlation was used to explore the relationship between continuous variables at P<0.05. The occurrence of MNC was 38.7% (95% confidence interval [95% CI]: 1.49 to 1.74). Commonly, MNCs were turning off patients (3.73 [standard deviation [SD]=0.99]), patient teaching/education (3.94 [SD=0.92]), review of collected lab results (3.77 [SD=1.10]), assessment of medication effectiveness (3.95 [SD=0.96]), attending interdisciplinary care conference (3.26 [SD=1.30]), and discussing patient expectations (3.77 [SD=1.13]). Inadequate number of staff (41.9%), inadequate number of support staff (38.7%), medications were not available when needed (41.9%), supplies/equipment not available when needed (43.5%), equipment not functioning correctly when needed (35.5%), tension of communication breakdowns with other department (32.3%), tension or communication breakdown within nursing team (32.3%), and communication breakdown with nurse assistant (32.3%) were the identified causes of MNC. Male nurses (Odds ratio [OR]: 1.1, 95% CI: 0.129 to 2.627), nurses who had less than one-year work experience (OR: 3.0, 95% CI: 0.090 to 71.820), nurses with diplomas (OR: 2.3, 95% CI: 0.017 to 16.468), and nurses with a degree as educational qualification (OR: 1.5, 95% CI: 0.170 to 5.395) were factors associated with MNC. The study concluded that a low occurrence of MNC was found. There is a critical need to enhance nursing care; nurses should improve their care regarding patient turning, patient teaching/education, review of collected lab results, communication, and assessment of medication effectiveness. Further investigation is required to gain a deeper insight into the reasons behind missed care and the criteria nurses use to prioritize neglected care.

Turki Aljuhani, Jayachandran Vetrayan, Mohammed A. Alfayez et al.

<b>Background</b>: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF in patients undergoing TKA and identify factors contributing to increased FOF. <b>Methods</b>: A prospective observational study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from April 2024 to December 2024. This study included 52 participants aged 20 to 75 years who had undergone primary TKA. Data were collected at two time points: after TKA and at three months post-surgery. The Short Falls Efficacy Scale-International (SFES-I) was used to assess the severity of FOF, and the Short Form 36 (SF-36) was used to measure the quality of life. Descriptive statistics, <i>t</i>-tests, and logistic regression were used for analysis. <b>Results</b>: This study included 52 participants (mean age: 63.77 ± 6.65 years; 82.7% female). Post-TKA, all participants exhibited high FOF (mean SFES-I score: 56.75 ± 8.30). After three months, the mean SFES-I score decreased significantly to 49.04 ± 12.45 (<i>t</i> = 4.408, <i>p</i> < 0.05). Post-TKA, SF-36 showed significant improvements in the physical function, role of physical limitations, bodily pain, vitality, social function, role of emotional limitations, and mental health subdomains. Bilateral total knee arthroplasty, body mass index, and some SF-36 subcomponents—such as general health, vitality, and role of emotional limitations—were identified as factors leading to increased FOF. <b>Conclusions</b>: FOF remains prevalent and severe in TKA patients, even at three months post-surgery, affecting rehabilitation outcomes. Early identification and tailored interventions for FOF should be considered essential components of comprehensive TKA recovery programs.

Sebastian Holm, MD, Mario Zambrana, MD, Juan E. Berner, MD, PhD et al.

Summary:. Generative artificial intelligence (AI) large language models are an emerging technology, with ChatGPT and Gemini being 2 well-known examples. The current literature discusses clinical applications and limitations of AI, but its role in research has not yet been extensively evaluated. This study aimed to assess the role of ChatGPT and Gemini in developing novel and clinically relevant research ideas (RIs) for systematic reviews (SRs) in head and neck reconstruction. ChatGPT and Gemini were prompted to provide 10 novel and clinically relevant RIs for SRs in the following domains: head and neck reconstruction in general, microsurgery, and complications in reconstructive head and neck procedures. A comprehensive search was then performed for SRs in MEDLINE, Cochrane Library, and Embase to determine the novelty of the RIs generated. A total of 60 RIs were generated, with half created by ChatGPT and the other half by Gemini. Overall, 3613 entries were found through the literature search. After deduplication and screening, a total of 50 studies that partially addressed the AI-generated RIs were identified and were included in the present review. Out of the 60 AI-generated RIs, 42 had not been previously studied and were therefore considered novel. No statistically significant differences were found between the outputs generated by Gemini and ChatGPT. Both ChatGPT and Gemini were able to effectively generate novel and clinically relevant RIs for SRs, although their suggestions were generally broad. This study demonstrated that AI could potentially aid in the process of conducting novel SRs.

Feifan Zhang, Zhiwei Sun, Zhenyu Zhang et al.

Abstract E2F family genes are common transcription factors, abnormal in several malignant tumors. However, their complex involvement in colorectal cancer, particularly in prognosis, immune infiltration, and mutational landscape, remains unclear. We conducted a study using gene expression data from the TCGA and GEO datasets to examine the abnormal expression of E2Fs in colorectal cancer. And we performed consensus clustering and differential gene expression analyses to identify E2Fs-related genes. Then, we used Lasso regression and multivariate Cox regression to create a prognostic risk model for colorectal cancer. We analyzed the differences between the E2Fs-based gene risk and various clinical characteristics, gene mutations, immune cell infiltration, immunotherapy responses, and drug sensitivity using clinicopathological data, single-cell RNA sequences, multiple immune algorithms. Finally, we have developed a prognostic risk model that includes FMO5, NDUFA11, LIPG, FIGNL1, MOGAT2, and GZMB. We observed significant differences in clinical characteristics, immune cell infiltration, gene mutation landscapes, immunotherapy responses, and drug sensitivity between the high-risk and low-risk groups. The novel E2Fs-based gene risk model shows significant potential for contributing to the evaluation of prognosis and predicting immunotherapeutic outcomes for colorectal cancer patients.

Yutaro Yamashita, Yoshiro Abe, Mayu Bando et al.

Background Free flap reconstruction can be performed in patients with chronic limb-threatening ischemia (CLTI). However, early walking training may increase the risk of wound dehiscence and prolong hospitalization. Total contact cast (TCC) treatment effectively addresses diabetic plantar ulcers by immobilizing the foot and distributing weight away from the ulcer area. This study aimed to assess the effect of postoperative TCC use on early limb loading and hospital stay in patients with CLTI with free flaps.

Zhihua Qiao, Xiancheng Wang, Hongli Zhao et al.

Abstract Background Exosomes (Exos) from adipose-derived stem cells (ADSCs) have a high inclusion content and low immunogenicity, which helps to control inflammation and accelerate the healing of wounds. Unfortunately, the yield of exosomes is poor, which raises the expense and lengthens the treatment period in addition to impairing exosomes’ therapeutic impact. Thus, one of the key problems that needs to be resolved in the current exosome study is increasing the exosome yield. Methods Tetraspanin-6 (TSPAN6) overexpression and knockdown models of ADSCs were constructed to determine the number of exosomes secreted by each group of cells as well as the number of multivesicular bodies (MVBs) and intraluminal vesicles (ILVs) within the cells. Subsequently, the binding region of the interaction between TSPAN6 and syntenin-1 was identified using the yeast two-hybrid assay, and the interaction itself was identified by immunoprecipitation. Finally, cellular and animal studies were conducted to investigate the role of each class of exosomes. Results When compared to the control group, the number of intracellular MVBs and ILVs was significantly larger, and the number of ADSCsTSPAN6+-Exos was more than three times higher. However, TSPAN6’s ability to stimulate exosome secretion was reduced as a result of syntenin-1 knockdown. Additional yeast two-hybrid assay demonstrated that the critical structures for their interaction were the N-terminal, Postsynaptic density protein 95/Discs large protein/Zonula occludens 1 (PDZ1), and PDZ2 domains of syntenin-1, and the C-terminal of TSPAN6. In animal trials, the wound healing rate was best in the ADSCsTSPAN6+-Exos group, while cellular experiments demonstrated that ADSCsTSPAN6+-Exos better enhanced the proliferation and migration of human skin fibroblasts (HSFs) and human umbilical vein endothelial cells (HUVECs). Conclusion TSPAN6 stimulates exosome secretion and formation, as well as the creation of MVBs and ILVs in ADSCs. Syntenin-1 is essential for TSPAN6’s stimulation of ADSCs-Exos secretion. Furthermore, ADSCsTSPAN6+-Exos has a greater ability to support wound healing, angiogenesis, and the proliferation and migration of a variety of cells.

Roopali Sehrawat, Nalini Bansal, Ajitabh Srivastava et al.

Basidiobolus ranarum is known to cause subcutaneous mycoses; however, rare cases of hepatic and gastrointestinal involvement by basidiobolomycosis have been reported. Hepatic basidiobolomycosis may be confused with a carcinoma on imaging, and histological examination and fungal culture can help distinguish between these two. We report a rare case of basidiobolomycosis in a 16-year-old male with liver and gastrointestinal involvement.

Jefferson W. Chen, Alex B. Valadka, M. Ross Bullock et al.

Quan Rui Tan, Russell Andrew Wong, Arun-Kumar Kaliya-Perumal et al.

The main advantage of Oblique Lumbar Interbody Fusion (OLIF) is its ability to provide safe access to the lumbar spine while being a robust interbody fusion technique through a minimally invasive approach. This study reviews the postoperative complications of OLIF, offering a comprehensive understanding of its advantages and disadvantages. A total of 27 studies with 1275 patients were shortlisted based on our selection criteria. Complications were categorized into intra-operative, immediate post-operative, and delayed post-operative and were interpreted based on surgical procedure into stand-alone OLIF, OLIF with posterior stabilisation, and unspecified. Major complications exhibited a pooled prevalence of just 1.7%, whereas the overall pooled prevalence of complications was 24.7%. Among the subgroups, the stand-alone subgroup had the lowest prevalence of complications (14.6%) compared to the unspecified subgroup (29.6%) and the OLIF L2-5 with posterior stabilisation subgroup (25.8%). Similarly, for major complications, the stand-alone subgroup had the lowest prevalence (1.4%), while the OLIF L2-5 with posterior stabilisation subgroup (1.8%) and the unspecified OLIF L2-5 subgroup (1.6%) had higher rates. However, the differences were not statistically significant. In conclusion, the rate of major complications after OLIF is minimal, making it a safe procedure with significant benefits outweighing the risks. The advantages of OLIF L2-5 with posterior stabilisation over stand-alone OLIF L2-5 is a subject of discussion.

Shih-Ho Wang, Chin-Hu Wu, Chin-Chuan Tsai et al.

<i>Taraxacum officinale</i> (dandelion) is often used in traditional Chinese medicine for the treatment of cancer; however, the downstream regulatory genes and signaling pathways mediating its effects on breast cancer remain unclear. The present study aimed to explore the effects of luteolin, the main biologically active compound of <i>T. officinale</i>, on gene expression profiles in MDA-MB-231 and MCF-7 breast cancer cells. The results revealed that luteolin effectively inhibited the proliferation and motility of the MDA-MB-231 and MCF-7 cells. The mRNA expression profiles were determined using gene expression array analysis and analyzed using a bioinformatics approach. A total of 41 differentially expressed genes (DEGs) were found in the luteolin-treated MDA-MB-231 and MCF-7 cells. A Gene Ontology analysis revealed that the DEGs, including AP2B1, APP, GPNMB and DLST, mainly functioned as oncogenes. The human protein atlas database also found that AP2B1, APP, GPNMB and DLST were highly expressed in breast cancer and that AP2B1 (cut-off value, 75%) was significantly associated with survival rate (<i>p</i> = 0.044). In addition, a Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that the DEGs were involved in T-cell leukemia virus 1 infection and differentiation. On the whole, the findings of the present study provide a scientific basis that may be used to evaluate the potential benefits of luteolin in human breast cancer. Further studies are required, however, to fully elucidate the role of the related molecular pathways.

Huapeng Lu, Qinling Yang, Fang Tian et al.

Objective. To study the association between sleep duration and the incidence of type 2 diabetes mellitus (T2DM) and to provide a theoretical basis for the prevention of T2DM through a meta-analysis. Methods. PubMed, Web of Science, Scopus, Embase, Cochrane Library, ProQuest, CNKI, Wanfang, VIP, and SINOMED were searched from their inception until May 2020. All cohort studies on the relationship between sleep duration and T2DM in adults were included. According to the inclusion and exclusion criteria, two authors independently assessed the literature and extracted the data. Metaregression and publication bias were evaluated, and sensitivity and meta-analyses were conducted with RevMan 5.3. Results. A total of 17 studies were collected, involving 737002 adults. The incidence of T2DM was 4.73% in short sleep duration (SSD) (t≤6 h), 4.39% in normal sleep duration (NSD) (6 h<t<9 h), and 4.99% in long sleep duration (LSD) (t≥9 h). The meta-analysis demonstrated that SSD increased the risk of T2DM compared with NSD (RR=1.22, 95% CI: 1.15-1.29, P<0.001), LSD increased the risk of T2DM compared with NSD (RR=1.26, 95% CI: 1.15-1.39, P<0.001), and the risk of T2DM has no significant difference between SSD and LSD (RR=0.97, 95% CI: 0.89-1.05, P=0.41). The sensitivity of each study was robust and the publication bias was weak. Conclusion. SSD or LSD can increase the risk of T2DM.

Yongzhi XU, Fang FANG, Jinghui WANG et al.

Background: Expression of miR‑92b in oral squamous cell carcinoma (OSCC) rat tissue and its effect on the OSCC CAL‑27 cells were investigated. Methods: The study was performed in Qingdao Stomatological Hospital, Qingdao, China on December 2018. Thirty Wistar rats were used to construct models of oral squamous cell carcinoma. CAL‑27 cells trascfected by Lipofectamine 2000 were divided into miR‑92b inhibitor, miR‑NC and blank groups. RT‑qPCR was used for the detection of the expression level of miR‑92b, and MTT and flow cytometry were carried out for the detection of the effect of miR‑92b on the proliferation and apoptosis of CAL‑27 cells, respectively. Results: The expression level of miR‑92b was significantly higher in tumor tissues than that in normal tissues (P<0.001). The miR‑92b inhibitor group had significantly lower proliferation ability but higher apoptosis rate of CAL‑27 cells than the miR‑NC and blank groups. After miR‑92b was downregulated by trans-fecting cells, the expression level of miR‑92b was significantly lower in the miR‑92b inhibitor group than that in the miR‑NC and blank groups. Conclusion: miR‑92b inhibitor can inhibit the proliferation of CAL‑27 cells and promote apoptosis, which provides certain references for clinical treatment. It is expected to be a potential target for treating OSCC.

Shigeru Fujisaki, Motoi Takashina, Ken-ichi Sakurai et al.

Abstract Background Hilar biliary stricture caused by isolated fungal infections in immunocompetent patients are considered to be extremely rare and difficult to the diagnose from the outset. Case presentation We report a unique case of granulomatous cholangitis based on isolated biliary fungal infection manifesting as obstructive jaundice and mimicking hilar cholangiocarcinoma in an immunocompetent woman. A 67-year-old Japanese woman was referred to our hospital for obstructive jaundice. She had been followed up for hypochondroplasia by the referring physician. Her total bilirubin level was 5.4 mg/dL. Viral hepatitis screening was found to be negative, and serum IgG4 was within normal limits; however, her CA19-9 level was high. Abdominal computed tomography revealed dilatation of the intrahepatic bile ducts. Abdominal echogram detected a solid mass in the hilar bile duct. Her magnetic resonance cholangiopancreatography has also revealed an abrupt stenosis of the primary biliary confluence with upstream dilatation of the intrahepatic bile ducts. Endoscopic nasobiliary drainage was then performed to improve the obstructive jaundice. Although biliary cytology did not reveal malignant findings, the bile duct in the hilum showed severe stenosis, and hilar cholangiocarcinoma could not be completely excluded. The patient had a developmental disorder based on chondrodystrophy. To avoid excessive surgical stress, such as hepatic lobectomy, we performed resection of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy reconstruction. Intraoperative frozen sections of the resection margins were determined to be negative for tumor. The resected specimen showed multiple strictures inside the common bile duct, numerous calculi in the lumen, and little free space. The final pathological diagnosis was granulomatous cholangitis due to fungal infection. The patient’s postoperative course was deemed uneventful. She was discharged from our hospital 23 days after surgery without antifungal treatment. Conclusions For a unique case of granulomatous cholangitis based on isolated biliary fungal infection mimicking hilar cholangiocarcinoma, we were able to avoid excessive invasion and performed appropriate surgical management.

Sevgi Kesici, Ugur Kesici, Hulya Ulusoy et al.

Introduction: Local anesthetic infiltration is used widely for post-operative analgesia in many situations. However the effects of local anesthetics on wound healing are not demonstrated clearly. This study planned to evaluate the effects of lidocaine, prilocaine, bupivacaine and levobupivacaine on wound healing, primarily on wound tensile strength and on collagen ultrastructure. Methods: This study was conducted on male Sprague Dawley rats. On days 0, 8th, 15th, and 21st, all animals were weighed and received a preincisional subcutaneous infiltration of 3 mL of a solution according the group. Control saline (C), lidocaine (L) 7 mg.kg−1, prilocaine (P) 2 mg.kg−1, bupivacaine (B) 2 mg.kg−1 and levobupivacaine (LVB) 2.5 mg.kg−1. The infiltrations were done at the back region 1.5 cm where incision would be performed at the upper, middle and lower part along the midline, under general anesthesia. Wound tensile strengths were measured after 0.7 cm × 2 cm of cutaneous and subcutaneous tissue samples were obtained vertical to incision from infiltrated regions. Tissue samples were also obtained for electron microscopic examination. Evaluations were on the 8th, 15th and 21st days after infiltration. Results: There was no difference between groups in the weights of the rats at the 0th, 8th, 15th and 21st days. The collagen maturation was no statistically different between groups at the 8th and 15th days. The maturation scores of the B and L groups at the 21st day was significantly lower than the Group C (1.40, 1.64 and 3.56; respectively). The wound tensile strength was no statistically different between groups at the 8th and 15th days but at the 21st day the Groups B and LVB had significantly lower value than Group C (5.42, 5.54 and 6.75; respectively). Conclusion: Lidocaine and prilocaine do not affect wound healing and, bupivacaine and levobupivacaine affect negatively especially at the late period. Resumo: Introdução: A infiltração de anestésico local é amplamente utilizada para analgesia pós-operatória em muitas situações. No entanto, os efeitos dos anestésicos locais na cicatrização de feridas não foram demonstrados claramente. Neste estudo planejamos avaliar os efeitos de lidocaína, prilocaína, bupivacaína e levobupivacaína sobre a cicatrização de feridas, principalmente sobre a força tênsil da ferida e a ultraestrutura do colágeno. Métodos: Este estudo foi realizado em ratos machos da linhagem Sprague Dawley. Nos dias 0, 8, 15 e 21, todos os animais foram pesados e receberam uma infiltração subcutânea pré-incisional de 3 mL de uma solução, de acordo com a designação dos grupos: Grupo C recebeu salina (controle); Grupo L recebeu lidocaína (7 mg.kg-1); Grupo P recebeu prilocaína (2 mg.kg-1); Grupo B recebeu bupivacaína (2 mg.kg-1); Grupo LVB recebeu levobupivacaína (2,5 mg.kg-1). As infiltrações foram feitas na região posterior a 1,5 cm de onde a incisão seria realizada na parte superior, média e inferior ao longo da linha média, sob anestesia geral. A força tênsil da ferida foi medida após amostras de 0,7 × 2 cm de tecido cutâneo e subcutâneo serem obtidas das regiões infiltradas, verticalmente à incisão. Amostras de tecido também foram obtidas para exame microscópico eletrônico. As avaliações foram realizadas nos dias 8, 15 e 21 após a infiltração. Resultados: Não houve diferença entre os grupos em relação ao peso dos ratos nos dias 0, 8, 15 e 21. A maturação do colágeno não foi estatisticamente diferente entre os grupos nos dias 8 e 15. Os escores de maturação dos grupos B e L no dia 21 foram significativamente inferiores aos do Grupo C (1,40, 1,64 e 3,56, respectivamente). A força tênsil da ferida não foi estatisticamente diferente entre os grupos nos dias 8 e 15, mas no dia 21, os grupos B e LVB apresentaram valores significativamente menores que o Grupo C (5,42, 5,54 e 6,75, respectivamente). Conclusão: Lidocaína e prilocaína não afetam a cicatrização de feridas, enquanto bupivacaína e levobupivacaína afetam negativamente, especialmente no período tardio. Keywords: Local anesthesia, Wound tension strength, Levobupivacaine, Bupivacaine, Lidocaine, Prilocaine, Palavras-chave: Anestesia local, Força tênsil da ferida, Levobupivacaína, Bupivacaína, Lidocaína, Prilocaína