Hasil untuk "Surgery"

Marco Marc Lianne Marco J Djuna L Thomas M Jeanin E Mark Del Chiaro Besselink Scholten Bruno Cahen Gress va

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring 5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

J. Shin, Mun-Young An, Si-Gyun Roh et al.

Purpose: The reverse digital island flap is useful for the repair of various finger-tip injuries. We present a modified surgical technique with skin strip elevation for the prevention of postoperative congestion. Methods: From January 2005 to October 2015, we performed 31 reconstructive procedures for finger injury using a reverse digital artery island flap with and without skin strip retention. Patients’ clinical characteristics, surgical outcomes, and complications were investigated. Results: All flaps survived and there were no donor site problems. The mean follow-up time was 5 months (range, 3–8 months). In skin strip retention group, mild venous congestion was observed in 1 case, although it resolved spontaneously. Another case retained flexion contracture, and 2 patients had stiffness at the distal interphalangeal joint. Whereas, in no retention group, venous congestion was observed in 3 cases, 1 patient had partial flap necrosis and 2 patient suffer in flexion contracture at metacarpophalangeal joint. Conclusion: The reverse digital island flap procedure produces consistent re-sults and is reliable for the treatment of fingertip injury. Our modified surgical technique of elevating the flap accompanied by skin strip retention helps prevent postoperative congestion.

Ruheng Hua, Jiawei Yu, Yuanjie Niu et al.

Abstract Objective Gastric cancer (GC) is a highly invasive malignancy with a propensity for lymph node metastasis. This study investigated how lactylation of TRIM29 contributes to the invasive behavior of GC and lymph node metastasis and the efficacy of chemotherapy for the disease. Methods We examined the expression levels of TRIM29 and its lactylation status in GC tissues and cell lines using quantitative reverse-transcription polymerase chain reaction, immunohistochemistry based on tissue microarrays and western blotting. Functional transwell migration, three-dimensional invasion assay and tube formation assays were performed to assess the role of TRIM29 in GC. The interaction between TRIM29 and heteronuclear ribonucleoprotein A1(hnRNPA1) was explored by co-immunoprecipitation and mass spectrometry. Results Expression of TRIM29 was significantly upregulated in GC tissues in comparison with adjacent non-tumor tissues. This upregulation was associated with lymph node metastasis, vascular tumors and a worse prognosis. Lactylation of TRIM29 in GC cells enhanced the migratory ability and invasiveness of these cells and lymph node metastasis. Mechanistically, TRIM29 formed a complex with hnRNPA1, which in turn activated the Wnt/β-catenin signaling pathway by stabilizing β-catenin in a ubiquitination-dependent manner. Targeting TRIM29 and lymphangiogenesis augmented the efficacy of 5-fluorouracil-based chemotherapy. Conclusion Lactylation of TRIM29 promotes invasive behavior and lymph node metastasis in GC cells by engaging the hnRNPA1-mediated Wnt/β-catenin pathway. Targeting TRIM29 and lymphangiogenesis may be a promising therapeutic strategy for patients with advanced GC.

Jian Cheng, Xiao Dong, Yang Yang et al.

Abstract Background Adverse events during pregnancy are implicated in increasing the risk of congenital malformations in offspring. Current research does not fully encompass the spectrum of adverse events nor the mechanisms by which they affect fetal development. Methods A two-sample and two-step Mendelian randomization (MR) study was conducted to assess the association between adverse events during pregnancy and congenital malformations in offspring, and to investigate the mediating role of circulating metabolites in linking these adverse events to congenital malformations. Results Maternal bleeding during pregnancy was associated with an increased risk of congenital ichthyosis and a decreased risk of congenital hydrocephalus. Anemia during pregnancy showed a significant correlation with an increased risk of atrioventricular septal defects. Placenta previa and placental abruption were associated with a decreased risk of congenital hydrocephalus and an increased risk of congenital malformation of the breast. Premature birth was associated with an increased risk of complex heart defects. Fetal malposition correlated with a decreased risk of cleft lip. Urogenital infection during pregnancy was linked to an increased risk of congenital malformation of cardiac chambers and connection. Glycine may mediate approximately 1.1% of the effect of premature birth on the risk of complex heart defects. Conclusion MR was employed to elucidate the mediating role of circulating metabolites in the impact of these adverse events on congenital malformations, providing new insights into their causal relationships. However, the underlying mechanisms remain unclear, necessitating further research and clinical trials to elucidate these relationships.

Evgeniya Melnik, Daria Akimova, Tatiana Markova et al.

Arthrogryposis multiplex congenita (AMC) is a large group of congenital conditions characterized by joint contractures affecting two or more body areas. A part of AMC type is caused by heterozygous pathogenic variants in genes encoding sarcomeric components of skeletal muscle fibers. Here we report a 7-year-old boy with a phenotype including AMC with dysmorphic facial features, short stature, congenital malformations of brain, colon and lacrimal canal. Trio whole-genome sequencing identified compound heterozygosity in the UTRN gene, consisting of a splicing variant in intron 57 (c.8434 + 1G>A) and a large heterozygous deletion spanning exons 3–51 (NM_007124.3). It is known that utrophin, the product of the UTRN gene, is an autosomal homologue and a fetal form of a protein of skeletal muscles - dystrophin. The presence of multiple malformations in the patient’s phenotype is consistent with ubiquitous expression of utrophin in the embryonic period. The RNA-seq analysis revealed that the splicing variant introduces a premature termination codon, which is predicted to result in a truncated protein shorter by 615 amino acids (p.Val2786Argfs*34), and the deletion leads to transcription of a shortened RNA isoform. We suggest that these variants are hypomorphic and partially retain protein function, which explains the clinical picture in the patient. In aggregate, our findings provide evidence that rare biallelic recessive variants in UTRN cause a novel autosomal recessive multiple congenital arthrogryposis.

Paweł Muszyński, Marlena Święcicka, Dominika Musiałowska et al.

Anomalies of coronary artery origins are rare but significant conditions that can range from benign to life-threatening. Early detection through imaging is crucial in preventing adverse outcomes. The treatment strategy varies depending on the type and severity of the anomaly, ranging from pharmacological treatment to surgery. A 22-year-old male patient, after syncope, after excluding other causes, had an exercise drill test, which was clinically negative and ECG-positive. Angio-CT revealed an undeveloped left main coronary artery (LMCA), and the circulation was supplied through the right coronary artery (RCA). The RCA provides the left anterior descending artery (LAD), and the LAD retrogradely supplies the left circumflex artery (LCX). The myocardial perfusion scintigraphy showed a slight lack of perfusion in the anterior wall (6% of total perfusion). The patient was qualified for further observation. A 77-year-old female underwent cardiac CT due to stenocardia. CT showed a lack of LMCA. The initial segment of the RCA gave rise to the left coronary artery (LCA), which encircled the aortic bulb posteriorly and bifurcated into branches resembling the LCX and LAD. After the Heart Team consultation, the patient was deemed eligible for conservative treatment. Angio-CT is a valuable tool for detecting coronary artery anomalies.

Jorge Montero-Cámara, Francisco José Ferrer-Sargues, María José Segrera Rovira et al.

I. B. Goldman

Sina Yarmoradian, Mehrdad Shahraki, Sadra Amirpour Haradasht

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Hassan Asadigandomani, Nader Mohammadi, Hamid Riazi-Esfahani et al.

A girl of 8 years old was referred to our clinic with a history of penetrating injury to her left eye 6 years ago with light perception vision and a large traumatic macular hole in her right eye. Her right eye’s vision was 4/10 when she first visited our clinic. Considering the patient’s one-eye status, her parents’ reluctance to undergo surgery, and the possibility of spontaneous closure of traumatic macular holes, it was determined to observe the patient and evaluate her visual acuity and macular hole condition. In 2 years, the final best corrected visual acuity was 8/10 in the right eye, with infratemporal eccentric fixation in visuoscopy. In addition to evaluating and reporting this case as a traumatic macular hole, we will discuss the role of nonsurgical treatment and the possibility of good visual acuity with eccentric fixation in a child with large traumatic macular hole.

Yixuan Tan, Jia Liu, Xiaoming Li et al.

Study designRetrospective study.ObjectiveControversy exists over the need for unilateral vs. bilateral pedicular percutaneous vertebroplasty (PVP) for patients with osteoporotic vertebral compression fractures (OVCFs). Clinical research is scarce comparing two approaches for multi-level PVP. This study aimed at evaluating the clinical and radiographic outcomes of multi-level PVP using two approaches for OVCFs.MethodsSeventy-eight patients with OVCFs undergoing multi-level PVP were enrolled including 36 patients undergoing unilateral PVP and 42 undergoing bilateral PVP. The clinical and radiological assessments including the Visual Analogue Scale (VAS), sagittal and coronal segmental Cobb, vertebral compression ratio (VCR), and vertebral sides ratio (VSR) were evaluated preoperatively and postoperatively.ResultsAll patients achieved a minimum 2-year follow-up. A total of 164 fractured vertebrae were enrolled. Regarding clinical efficacy, the VAS score improved in both groups after surgery, but the two groups did not differ significantly. The changes tendency in Sagittal Segmental Cobb, VSR, and VCR were similar postoperatively, and no statistically significant difference between groups. As for the Coronal Segmental Cobb angle, patients in unilateral and bilateral groups were shown to have 5.0° ± 4.0° and 2.6° ± 2.2° degrees loss of correction at a minimum 2-years follow-up duration, respectively. The loss of correction in the Coronal Segmental Cobb of unilateral group was significantly greater than that of bilateral group.ConclusionBoth multi-level unilateral and bilateral pedicular PVP achieved significant pain reduction and vertebral height restoration. Moreover, the bilateral PVP has shown advantages in stabilizing Coronal Cobb angle in patients with OVCFs.

Gonzalo de Cabo, M.D., Nuria Álvarez-Benito, M.D., Pablo Ramos-Murillo, M.D. et al.

Several arthroscopic techniques to treat anterior shoulder instability have been described. Bankart repair may be insufficient in cases with some degree of bone loss, and arthroscopic Latarjet is technically challenging. It is not rare to find at the time of surgery a more extensive labral tear (SLAP lesion) or an insufficient anterior capsulolabral tissue. We describe for those cases a dynamic anterior stabilization where using the long head of the biceps we are treating the SLAP lesion and at the same time it provides the “sling effect” of a Latarjet procedure for the anterior instability.

Vafi Salmasi, Theresa R. Lii, Keith Humphreys et al.

Abstract. The ability of clinical trials to inform the care of chronic pain may be limited if only an unrepresentative subset of patients are allowed to enroll. We summarize and report new insights on published studies that report on how trial exclusions affect the generalizability of their results. We conducted a PubMed search on the following terms: ((“eligibility criteria” AND generalizability) OR (“exclusion criteria” AND generalizability) OR “exclusion criteria”[ti] OR “eligibility criteria”[ti]) AND pain. We only considered studies relevant if they analyzed data on (1) the prevalence and nature of exclusion criteria or (2) the impact of exclusion criteria on sample representativeness or study results. The 4 articles that were identified reported differences in patients who were included and excluded in different clinical trials: excluded patients were older, less likely to have a paid job, had more functional limitations at baseline, and used strong opioids more often. The clinical significance of these differences remains unclear. The pain medicine literature has very few published studies on the prevalence and impact of exclusion criteria, and the outcomes of excluded patients are rarely tracked. The frequent use of psychosocial exclusions is especially compromising to generalizability because chronic pain commonly co-occurs with psychiatric comorbidities. Inclusion of more representative patients in research samples can reduce recruitment barriers and broaden the generalizability of findings in patients with chronic pain. We also call for more studies that examine the use of exclusion criteria in chronic pain trials to better understand their implications.

Tyler J. Gregory, P.T., D.P.T., Samuel A. Rauchwarter, P.T., D.P.T., S.C.S., Michael D. Feldman, M.D.

Dry needling is most commonly used in the subacute and chronic phases of an injury; therefore, it is imperative to understand the use of dry needling in the acute phases of an injury. There are four main reasons to use dry needling during the acute phase of injury: to relieve pain, decrease edema, increase range of motion and flexibility, and increase strength and power. Dry needling can be used pregame, postgame, during half time or an intermission, or following an injury. Although further research is needed, acute dry needling can be used to bolster athletes’ health and possibly improve sports performance.

Vinicius Lima, MD, Noel Schechtman, MD, David Araujo Junior, MD et al.

Chronic subdural hematoma (cSDH) is classically defined as a collection of blood in the space between the dura mater and arachnoid meninges. Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the middle meningeal artery (MMA) the most used technique, though the best embolization material is still subject to studies. Methods: we present the detailed description of the technique for MMA embolization with a 20% solution of NBCA for the treatment of chronic subdural hematoma. Discussion: Endovascular treatment for selected cases of chronic subdural hematoma has been increasingly reported in the literature, being the embolization of the MMA the most used technique, though the best embolization material is still subject to studies. NBCA is a low-cost embolic agent that has been used for a long time in endovascular treatments. Conclusion: There is great potential for MMA embolization in the management of chronic subdural hematomas, either as a single or adjuvant treatment. NBCA represents an effective and low-cost material.

Di Cao, Mengyi Li, Yang Liu et al.

Abstract Background The magnetic resonance imaging (MRI)-based proton density fat fraction (PDFF) has become popular for quantifying liver fat content. However, the variability of the region-of-interest (ROI) sampling strategy may result in a lack of standardisation of this technology. In an effort to establish an accurate and effective PDFF measurement scheme, this study assessed the pathological correlation, the reader agreement, and time-burden of different sampling strategies with variable ROI size, location, and number. Methods Six-echo spoiled gradient-recalled-echo magnitude-based fat quantification was performed for 50 patients with obesity, using a 3.0-T MRI scanner. Two readers used different ROI sampling strategies to measure liver PDFF, three times. Intra-reader and inter-reader agreement was evaluated using intra-class correlation coefficients and Bland‒Altman analysis. Pearson correlations were used to assess the correlation between PDFFs and liver biopsy. Time-burden was recorded. Results For pathological correlations, the correlations for the strategy of using three large ROIs in Couinaud segment 3 (S3 3L-ROI) were significantly greater than those for all sampling strategies at the whole-liver level (P < 0.05). For inter-reader agreement, the sampling strategies at the segmental level for S3 3L-ROI and using three large ROIs in Couinaud segment 6 (S6 3L-ROI) and the sampling strategies at the whole-liver level for three small ROIs per Couinaud segment (27S-ROI), one large ROI per Couinaud segment (9L-ROI), and three large ROIs per Couinaud segment (27S-ROI) had limits of agreement (LOA) < 1.5%. For intra-reader agreement, the sampling strategies at the whole-liver level for 27S-ROI, 9L-ROI, and 27L-ROI had both intraclass coefficients > 0.995 and LOAs < 1.5%. The change in the time-burden was the largest (100.80 s) when 9L-ROI was changed to 27L-ROI. Conclusions For hepatic PDFF measurement without liver puncture biopsy as the gold standard, and for general hepatic PDFF assessment, 9L-ROI sampling strategy at the whole-liver level should be used preferentially. For hepatic PDFF with liver puncture biopsy as the gold standard, 3L-ROI sampling strategy at the puncture site segment is recommended.

Binyamin Ben Avraham, Marisa Generosa Crespo‐Leiro, Gerasimos Filippatos et al.

Abstract The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD‐supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD‐supported patients. The expected and non‐expected device‐related and patient–device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD‐supported patients, mainly those supported with the ‘destination therapy’ indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD‐supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non‐LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non‐LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast‐growing population of LVAD‐supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD‐supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD‐supported patients.

Simon Timbrell, Hosam Aglan, Angela Cramer et al.

Abstract Cancer stem-like cells (CSC) contribute to therapy resistance and recurrence. Focal adhesion kinase (FAK) has a role in CSC regulation. We determined the effect of FAK inhibition on breast CSC activity alone and in combination with adjuvant therapies. FAK inhibition reduced CSC activity and self-renewal across all molecular subtypes in primary human breast cancer samples. Combined FAK and paclitaxel reduced self-renewal in triple negative cell lines. An invasive breast cancer cohort confirmed high FAK expression correlated with increased risk of recurrence and reduced survival. Co-expression of FAK and CSC markers was associated with the poorest prognosis, identifying a high-risk patient population. Combined FAK and paclitaxel treatment reduced tumour size, Ki67, ex-vivo mammospheres and ALDH+ expression in two triple negative patient derived Xenograft (PDX) models. Combined treatment reduced tumour initiation in a limiting dilution re-implantation PDX model. Combined FAK inhibition with adjuvant therapy has the potential to improve breast cancer survival.

Mohammad Chehrazi, Zahra Geraili, Seyed Mozafar Rabiei et al.

Abstract Background Cataract surgery is most commonly done under local anesthesia with anesthesia and sedation controlled. Anesthetic depth and awareness monitoring during surgery frequently lead to irregular-timed observations. Inappropriate choice of working correlation structure in generalized estimating equations (GEE) may lead to inefficient estimation of parameters. The aim of this study was to apply the two new criteria to the anesthesia data for cataract surgery, to select and compare different candidates for working structure. Methods In this randomized controlled trial, anesthesia depth and hemodynamic changes were considered to be the primary outcome. The first group received propofol at a dose of 50‑75 μg/kg/min and the second group received 1% isoflurane. We developed a GEE regression model based on several candidates for the working correlation framework and then evaluated it according to CEBIC (Constraint Empirical Bayesian Information Criterion) and CEAIC (Constraint Empirical Akaike Information Criterion) criteria. Data analysis was performed using the R software 3.6.1. Results The mean age of the propofol group was 67.46 years (SD = 12.46 years) and 64.53 years for the isoflurane group (SD = 13.77 years). The mean BIS in isoflurane was higher among all time points than the propofol group, but only the difference between the two groups was statistically significant in 3 min after surgery (P = 0.04). On the basis of the CEAIC and CEBIC criteria, an independent working correlation was the best structure for the BIS outcome. In addition, the best structure was the unstructured correlation for HR. The MAP (mean arterial pressure) parameter estimate results revealed that the AR (1) structure was a good choice. Conclusion In comparison to CIC and QIC, two CEAIC and CEBIC criteria have chosen a different structure for the working correlation between repeated measurements of anesthetic indices obtained during cataract surgery.