Hasil untuk "Surgery"

Justin Ren, PhD, Colin Royse, MBBS, MD, David H. Tian, MD, PhD et al.

Kazuhiro Ichihara, In Dae Jong

We study cosmetic surgeries on a knot in a homology sphere. Several constraints on knots and surgery slopes to admit such surgeries are given. Our main ingredient is the rational surgery formula of the Casson--Walker invariant for 2-component links in the 3-sphere.

Gabriel Amorim Moreira Alves, Masatoki Teranishi, Ana Claudia Teixeira de Castro Gonçalves Ortega et al.

Substance use disorders (SUDs) remain a major public health challenge, with existing pharmacotherapies offering limited long-term efficacy. Traditional treatments focus on dopaminergic systems but often overlook the complex interplay between metabolic signals, neuroplasticity, and conditioned behaviors that perpetuate addiction. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), originally developed for type 2 diabetes and obesity, have recently emerged as promising modulators of reward-related brain circuits. This review synthesizes current evidence on the role of glucagon-like peptide-1 (GLP-1) and its receptor in modulating craving and substance-seeking behaviors. We highlight how GLP-1 receptors are expressed in addiction-relevant brain regions, including the ventral tegmental area (VTA), nucleus accumbens (NAc), and prefrontal cortex (PFC), where their activation influences dopaminergic, glutamatergic, and GABAergic neurotransmission. In addition, we explore how GLP-1 signaling affects reward processing through gut–brain vagal pathways, hormonal crosstalk, and neuroinflammatory mechanisms. Preclinical studies demonstrate that GLP-1RAs attenuate intake and relapse-like behavior across a range of substances, including alcohol, nicotine, and cocaine. Early-phase clinical trials support their safety and suggest potential efficacy in reducing craving. By integrating findings from molecular signaling, neurocircuitry, and behavioral models, this review provides a translational perspective on GLP-1RAs as an emerging treatment strategy in addiction medicine. We propose that targeting gut–brain metabolic signaling could provide a novel framework for understanding and treating SUDs.

Suyang Chen, Cai Yu

Introduction: An oroantral fistula (OAF) is an abnormal connection between the oral cavity and the maxillary sinus, usually occurred after the removal of maxillary premolar and molar teeth. Many techniques have been described for closure of oroantral fistulas but ignoring restoration of bony defects secondary to OAFs. This report presents a novel three-layered method for repairing OAFs with biomaterials sandwiched between the maxillary sinus floor mucosa and the palatal flap. Case description: A 59-year-old female patient was admitted to clinic with an oroantral fistula, of which the diameter was 6 mm. Firstly, peripheral soft tissue of the fistula was utilized to repair the maxillary sinus floor mucosa. And then, a mineralized collagen plug was placed over the sinus mucosa. Finally, the fistula was completely covered by a palatal flap. The follow-up period lasted for 6 months to evaluate the closure of the OAF and bone regeneration. Discussion: To yield adequate bone, a mineralized collagen plug was used to maintain space and promote bone generation. Compared with a buccal flap, a pedicled palatal flap has advantages of offering well-keratinized gingiva, not reducing the ridge height and better blood supply, thus ensuring success of both the closure of OAFs and the subsequent implant placement. Conclusion/clinical significance: The closure was successfully achieved without any signs of inflammation in the maxillary sinus and regenerative bone was observed after 6 months. The triple-layered technique is an effective procedure to repair OAFs.

Li Sun, Hai-Yan Gu, Guan-Hua Xu et al.

ObjectiveThe aim of this study is to develop and validate a prediction model for fall risk factors in hospitalized older adults with osteoporosis.MethodsA total of 615 older adults with osteoporosis hospitalized at a tertiary (grade 3A) hospital in Nantong City, Jiangsu Province, China, between September 2022 and August 2023 were selected for the study using convenience sampling. Fall risk factors were identified using univariate and logistic regression analyses, and a predictive risk model was constructed and visualized through a nomogram. Model performance was evaluated using the area under the receiver operator characteristic curve (AUC), Hosmer-Lemeshow goodness-of-fit test, and clinical decision curve analysis, assessing the discrimination ability, calibration, and clinical utility of the model.ResultsBased on logistic regression analysis, we identified several significant fall risk factors for older adults with osteoporosis: gender of the study participant, bone mineral density, serum calcium levels, history of falls, fear of falling, use of walking aids, and impaired balance. The AUC was 0.798 (95% CI: 0.763–0.830), with a sensitivity of 80.6%, a specificity of 67.9%, a maximum Youden index of 0.485, and a critical threshold of 121.97 points. The Hosmer-Lemeshow test yielded a χ2 value of 8.147 and p = 0.419, indicating good model calibration. Internal validation showed a C-index of 0.799 (95% CI: 0.768–0.801), indicating the model’s high discrimination ability. Calibration curves showed good agreement between predicted and observed values, confirming good calibration. The clinical decision curve analysis further supported the model’s clinical utility.ConclusionThe prediction model constructed and verified in this study was to predict fall risk for hospitalized older adults with osteoporosis, providing a valuable tool for clinicians to implement targeted interventions for patients with high fall risks.

Rima Chatterjee, Marc Kegel

We classify all contact structures with contact surgery number one on the Brieskorn sphere Sigma(2,3,11) with both orientations. We conclude that there exist infinitely many non-isotopic contact structures on each of the above manifolds which cannot be obtained by a single rational contact surgery from the standard tight contact 3-sphere. We further prove similar results for some lens spaces: We classify all contact structures with contact surgery number one on lens spaces of the form L(4m+3,4). Along the way, we present an algorithm and a formula for computing the Euler class of a contact structure from a general rational contact surgery description and classify which rational surgeries along Legendrian unknots are tight and which ones are overtwisted.

Jari Dahmen MD, Julian Hollander Bsc, Kishan Ramsodit et al.

Category: Ankle Introduction/Purpose: The aim of this study is to assess the return to sports rate and times after treatment of osteochondral lesions of the ankle in elite level athletes. Methods: All elite level athletes treated for an OLT(P) were selected from a cross-sectional database consisting of consecutive patients with cartilage injuries of the ankle and subsequently underwent prospective follow-up. Outcomes included return to sports outcomes, patient reported outcomes and a qualitative assessment regarding mental health Results: 26 patients with a median age of 22 years (IQR: 19.0 – 24.5) were included with a median follow-up time of 48 months (IQR: 34.5 – 71.0). Seven patients (27%) underwent conservative treatment and 19 patient (73%) operative treatment. Conservative treatment yielded a return to sport rate at any level of 86%, return to pre-injury and return to performance level of both 57%. For operative treatment these rates were 100%, 74% and 63% respectively. Mean time to return to pre-injury level overall was 8.3 months. At latest follow-up only 11 patients (44%) were still active at an elite level of sport. Conclusion: Both conservative and surgical treatment for osteochondral lesions of the ankle yielded return to sport rates above 86% in elite level athletes. The results of this study can be used in the decision-making process between the physician and the elite athlete to inform them about the expected return to sport rates and times for the different treatment options for OLT(P)s. As most athletes at the time of injury and treatment are still highly motivated and disciplined to return to their sport at the same level and be able to compete at the highest level available in their sport.

Maria Aamir, Mouza Al Ameri, Subhashini Ganesan et al.

Abstract Background Breast cancer is the most common cancer among women in the United Arab Emirates; yet there is little known about the psychosocial concerns of the survivors. Research shows that meeting the psychosocial needs significantly contributes to cancer survivor’s wellbeing and potentially elevates the quality of the patient’s life. Therefore the study aims to understand the psychosocial needs of breast cancer survivors through a qualitative approach. Methods A qualitative study was conducted using semi structured in-depth interviews among ten breast cancer survivors. The recorded texts were coded and salient themes were generated using an inductive approach. Thematic analysis of the interviews was done observing for meaning, repeating phrases and keywords. Results Analysis yielded three major themes which included survivors’ living experience with breast cancer, concerns of breast cancer survivors and the survivors’ expectations of healthcare delivery or support needed. The breast cancer survivors had psychosocial concerns that are not well understood and addressed by the healthcare. The experiences, concerns and expectations differ from individuals and through the continuum of survivorship. Conclusion Understanding the unmet psychosocial concerns of the cancer survivors is essential to design a structured survivorship program and offer timely and effective interventions. This would improve survivorship care in the country and offers opportunities to redesign cancer services towards patient-centred care.

Homid Fahandezh-Saddi Díaz, MD, PhD, Fátima Bebea Zamorano, MD, Jorge Enrique Ruiz Zafra, MD et al.

Summary:. Tendon transfers can be tied too tight or too loose. Both impede good function after surgery. Performing tendon transfers without sedation and pain during the surgery and then watching the patient move the transfer have helped us adjust the tension more accurately. This method can be applied to complex transfers such as radial nerve palsy triple tendon transfers. We describe the technique and results of a triple tendon transfer using wide-awake local anesthesia no tourniquet in a patient with a high radial nerve palsy. This was a complex case of reconstruction after five operations at the level of the humerus. This left him with a pseudoarthrosis of the humerus and a complete radial nerve palsy. We performed tendon transfers of pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to extensor pollicis longus tendons. Eighteen months after the triple tendon transfer surgery for the radial nerve palsy, the patient has good extension of the fingers, wrist, and thumb. He can open and close the hand properly. He has excellent function and mobility allowing him to perform most activities in a manner that is practically normal. Wide-awake local anesthesia no tourniquet can be used safely and successfully in complex cases requiring triple radial nerve tendon transfers of pronator teres to extensor carpi radialis brevis, flexor carpi ulnaris to extensor digitorum communis, and palmaris longus to extensor pollicis longus tendons.

Xiaohu Zhou, Xiaohu Zhou, Qiang Sun et al.

Peroxidasin (PXDN), also known as vascular peroxidase-1, is a newly discovered heme-containing peroxidase; it is involved in the formation of extracellular mesenchyme, and it catalyzes various substrate oxidation reactions in humans. However, the role and specific mechanism of PXDN in tumor are unclear, and no systematic pan-cancer studies on PXDN have been reported to date. This study employed data from multiple databases, including The Cancer Genome Atlas and The Genotype-Tissue Expression, to conduct a specific pan-cancer analysis of the effects of PXDN expression on cancer prognosis. Further, we evaluated the association of PXDN expression with DNA methylation status, tumor mutation burden, and microsatellite instability. Additionally, for the first time, the relationship of PXDN with the tumor microenvironment and infiltration of fibroblasts and different immune cells within different tumors was explored, and the possible molecular mechanism of the effect was also discussed. Our results provide a comprehensive understanding of the carcinogenicity of PXDN in different tumors and suggest that PXDN may be a potential target for tumor immunotherapy, providing a new candidate that could improve cancer clinical diagnosis and treatment.

Michele Tomasi, Elena Caproni, Mattia Benedet et al.

A growing body of evidence supports the notion that the gut microbiome plays an important role in cancer immunity. However, the underpinning mechanisms remain to be fully elucidated. One attractive hypothesis envisages that among the T cells elicited by the plethora of microbiome proteins a few exist that incidentally recognize neo-epitopes arising from cancer mutations (“molecular mimicry (MM)” hypothesis). To support MM, the human probiotic Escherichia coli Nissle was engineered with the SIINFEKL epitope (OVA-E.coli Nissle) and orally administered to C57BL/6 mice. The treatment with OVA-E.coli Nissle, but not with wild type E. coli Nissle, induced OVA-specific CD8+ T cells and inhibited the growth of tumors in mice challenged with B16F10 melanoma cells expressing OVA. The microbiome shotgun sequencing and the sequencing of TCRs from T cells recovered from both lamina propria and tumors provide evidence that the main mechanism of tumor inhibition is mediated by the elicitation at the intestinal site of cross-reacting T cells, which subsequently reach the tumor environment. Importantly, the administration of Outer Membrane Vesicles (OMVs) from engineered E. coli Nissle, as well as from E. coli BL21(DE3)ΔompA, carrying cancer-specific T cell epitopes also elicited epitope-specific T cells in the intestine and inhibited tumor growth. Overall, our data strengthen the important role of MM in tumor immunity and assign a novel function of OMVs in host-pathogen interaction. Moreover, our results pave the way to the exploitation of probiotics and OMVs engineered with tumor specific-antigens as personalized mucosal cancer vaccines.

Surena Hozoori

We discuss a metric description of the divergence of a (projectively) Anosov flow in dimension 3, in terms of its associated growth rates and give metric and contact geometric characterizations of when a projectively Anosov flow is Anosov. Then, we study the symmetries that the existence of an invariant volume form yields on the geometry of an Anosov flow, from various viewpoints of the theory of contact hyperbolas, Reeb dynamics and Liouville geometry, and give characterizations of when an Anosov flow is volume preserving in terms of those theories. We finally use our study to show that the bi-contact surgery operations of Salmoiraghi can be applied in an arbitrary small neighborhood of a periodic orbit of any Anosov flow. In particular, we conclude that the Goodman surgery of Anosov flows can be performed using a bi-contact surgery of Salmoiraghi.

Abdullah Al Mamun, Yanqing Wu, Ilma Monalisa et al.

Background: Currently, spinal cord injury (SCI) is a pathological incident that triggers several neuropathological conditions, leading to the initiation of neuronal damage with several pro-inflammatory mediators' release. However, pyroptosis is recognized as a new programmed cell death mechanism regulated by the stimulation of caspase-1 and/or caspase-11/-4/-5 signaling pathways with a series of inflammatory responses. Aim: Our current review concisely summarizes the potential role of pyroptosis-regulated programmed cell death in SCI, according to several molecular and pathophysiological mechanisms. This review also highlights the targeting of pyroptosis signaling pathways and inflammasome components and its therapeutic implications for the treatment of SCI. Key scientific concepts: Multiple pieces of evidence have illustrated that pyroptosis plays significant roles in cell swelling, plasma membrane lysis, chromatin fragmentation and intracellular pro-inflammatory factors including IL-18 and IL-1β release. In addition, pyroptosis is directly mediated by the recently discovered family of pore-forming protein known as GSDMD. Current investigations have documented that pyroptosis-regulated cell death plays a critical role in the pathogenesis of multiple neurological disorders as well as SCI. Our narrative article suggests that inhibiting the pyroptosis-regulated cell death and inflammasome components could be a promising therapeutic approach for the treatment of SCI in the near future.

Samla Gauri Balakrishnan, Mohd Ridzuan Ahmad, Seyed Saeid Rahimian Koloor et al.

Introduction: Conventional biopsy, based on extraction from a tumor of a solid tissue specimen requiring needles, endoscopic devices, excision or surgery, is at risk of infection, internal bleeding or prolonged recovery. A non-invasive liquid biopsy is one of the greatest axiomatic consequences of the identification of circulating tumor DNA (ctDNA) as a replaceable surgical tumor bioQpsy technique. Most of the literature studies thus far presented ctDNA detection at almost final stage III or IV of cancer, where the treatment option or cancer management is nearly impossible for diagnosis. Objective: Hence, this paper aims to present a simulation study of extraction and separation of ctDNA from the blood plasma of cancer patients of stage I and II by superparamagnetic (SPM) bead particles in a microfluidic platform for early and effective cancer detection. Method: The extraction of ctDNA is based on microfiltration of particle size to filter some impurities and thrombocytes plasma, while the separation of ctDNA is based on magnetic manipulation to high yield that can be used for the upstream process. Result: Based on the simulation results, an average of 5.7 ng of ctDNA was separated efficiently for every 10 µL blood plasma input and this can be used for early analysis of cancer management. The particle tracing module from COMSOL Multiphysics traced ctDNA with 65.57% of sensitivity and 95.38% of specificity. Conclusion: The findings demonstrate the ease of use and versatility of a microfluidics platform and SPM bead particles in clinical research related to the preparation of biological samples. As a sample preparation stage for early analysis and cancer diagnosis, the extraction and separation of ctDNA is most important, so precision medicine can be administered.

Keitaro Miyake, Kyoko Shirai, Nobuhiro Nishiyama et al.

Abstract Cochlear implants (CIs) are generally considered useful in the treatment of hereditary hearing loss with progressive deafness. Early CI can be beneficial for maintaining social activities in POU4F3 mutation patients.

Kristen Hendricks, Jennifer Hom, Matthew Stoffregen et al.

We establish a surgery exact triangle for involutive Heegaard Floer homology by using a doubling model of the involution. We use this exact triangle to give an involutive version of Ozsváth-Szabó's mapping cone formula for knot surgery. As an application, we use this surgery formula to give examples of integer homology spheres that are not homology cobordant to any linear combination of Seifert fibered spaces.

Megan Yu

Photo by Scott Van Daalen on Unsplash INTRODUCTION LASIK surgery, one of the most common elective procedures worldwide, aims to decrease or eliminate the need to wear glasses or contact lenses by reshaping the cornea’s curvature to restore the eye’s refractive power.[1] There is a popular belief among the public that the procedure is “virtually foolproof”,[2] which is largely shaped by LASIK advertising and marketing techniques.[3] However, recent studies and news reports suggest that complications after LASIK surgery are not uncommon and that many eye centers and LASIK advertisements continue to promise “20/20 vision or your money back” or fail to disclose possible LASIK complications.[4] In fact, a recent study conducted by the U.S. Food and Drug Administration (FDA) found that 1 to 4 percent of participants were dissatisfied with the visual complications after LASIK surgery.[5] Misleading information provided to the public about the procedure contributes to the popularity of LASIK. This paper discusses the ethical issues currently associated with both advertising and physicians’ disclosures of risks surrounding the procedure and provides recommendations to address these LASIK complications. LASIK is the most popular procedure used to correct the refractive error, which includes myopia and hyperopia.[6] Using this procedure, the ophthalmologist reshapes the cornea by removing eye tissue in different areas depending on the patient’s condition.[7] A flap approximately the size of a contact lens is formed using a femtosecond laser. This flap folds back in place and adheres to the corneal surface.[8] ANALYSIS Misleading LASIK Advertising & Failure to Disclose Business Relationships Misleading advertisements that portray LASIK surgery as a complication-free procedure are unethical. Many eye centers continue to display misleading advertisements by using phrases such as “20/20 vision or your money back” or “package deals.”[9] Direct to consumer advertisements created by ophthalmology groups, laser vision centers, and other LASIK providers make inflated claims regarding the efficacy or safety of LASIK surgery. For instance, some feature images that imply patients who had undergone LASIK surgery would be permanently free from glasses or claim LASIK surgery is a “safe and painless” alternative to glasses and omit any relevant complications of LASIK surgery.[10] Complex bioethical issues arise from false and misleading advertising. Any partnership ophthalmologists have with the companies that manufacture LASIK surgery equipment undermines physician integrity and may create pressure on ophthalmologists not to disclose LASIK surgery’s risks and limitations. Deceptive marketing tactics and business profits may also interfere with the physician’s professional obligation to patients and entice a patient to undergo risky surgery. These issues violate the principle of non-maleficence because they expose patients to unnecessary risks violating physicians’ obligations not to harm patients. Patients also suffer financially, as they may have to pay thousands of dollars for a procedure that may be ineffective or harmful. Ophthalmologists also violate the principles of virtue ethics and beneficence because physicians should display virtuous qualities, such as integrity and honesty in their practice and should promote good to their patients. The American Academy of Ophthalmology (Academy) and the FDA should oversee the behavior of ophthalmologists to ensure any financial or professional ties they have with the manufacturers that make the lasers for LASIK surgery do not override the professional obligation to disclose the risks and limitations of LASIK surgery. Government and professional associations should also discourage scientific journals from publishing studies where the authors have financial or professional ties with manufacturers that make the lasers used in LASIK surgery unless full disclosure is made clear. Financial ties and perverse incentives to overtreat are ethical issues that undermine trust. Failure to Disclose Possible Complications of LASIK Surgery by Ophthalmologists The FDA and the Academy have issued statements that compel ophthalmologists to properly inform patients of the indications, limitations, and complications of LASIK surgery and the lasers used during this procedure in 2008, 2009, and 2011.[11] Yet some ophthalmologists neglect to disclose possible LASIK surgery complications to patients or fail to take the time to answer patients’ questions regarding LASIK surgery,[12] which could cause long-term medical harm to the patient. In 2019, two Canadians filed a lawsuit against LASIK MD Clinics for neglecting to warn them that they could potentially develop corneal neuralgia after LASIK surgery,[13] which is a rare complication of LASIK surgery that is often misdiagnosed as dry eye.[14] Some patients have reported years of suffering from debilitating eye pain and visual symptoms such as glares and halos,[15] and some patients who had undergone LASIK surgery testified at an FDA meeting that they experienced impaired vision after LASIK surgery that resulted in job loss and social isolation. Suicides have also been reported.[16] Based on patient reporting of adverse events, ophthalmologists must disclose serious consequences. A failure to disclose complications of any medical procedure is a severe ethical breach. In the US, Canterbury v. Spence set forth a strong stance on failure to disclose rare severe side effects.[17] Informed consent is a cornerstone of bioethics—patients must know the risks before they agree to undergo any procedure. The moral foundation of informed consent is the protection of bodily integrity and respect for autonomy.[18] Patients have a fundamental liberty interest in being free of non-consensual bodily intrusion. Without accurate information, informed consent has not transpired; the agreement to undergo the procedure is based on misinformation. Doctors must disclose risks to educate the patient. It is the doctor’s duty to ensure that the patient is informed. Failing to disclose LASIK surgery’s possible complications violates the principles of virtue ethics and non-maleficence as it withholds knowledge from patients that is essential to the sound management of their health. It also tarnishes the doctor-patient relationship's fiduciary nature as patients may place less trust in their physicians after discovering they withheld essential knowledge from them. There is moral value in the life-changing benefits of LASIK Surgery Restoring one’s vision can be life-changing for many patients. Those who previously had to rely on glasses or contact lenses to see clearly could feel empowered and gain more autonomy after having LASIK surgery. LASIK helps patients avoid having contact lens intolerance. A successful LASIK surgery also allows patients to pursue certain professions or sports that they previously could not, such as becoming a chef or swimming. The ethics of advertising to enable potential LASIK patients to learn more about LASIK are compelling. More patients with poor vision will learn about an important solution. Advertising brings patients to doctors who must discuss the procedure realistically. Advertising LASIK would be ethically prohibited if it drew in patients with unrealistic expectations, and the doctor did not clearly state the efficacy, risks, and side effects. Continuing to allow advertising is the better moral choice as it allows many in need of help to seek it. However, it is a moral choice that is dependent on truth-telling and full disclosure by doctors. Despite the life-altering benefits of LASIK surgery, ophthalmologists have a professional obligation to patients and the public to provide truthful, informative advertising of LASIK surgery and ensure patients fully understand the purpose, benefits, limitations, and complications of LASIK surgery before having the procedure. Beneficence should compel ophthalmologists to act in the best interests of patients, as the intended purpose of LASIK surgery is to help patients improve their vision. LASIK can be a life-changing improvement ethically compelling its availability to patients for whom it is the right fit. Appropriate advertising and risk disclosure empower the patient in making an informed decision to undergo LASIK surgery. Actions to ensure an ethical process for patients deciding to undergo LASIK surgery To ensure full transparency, ophthalmologists should confirm patients understand the nature, purpose, and risks of the procedure by encouraging them to ask questions during consultations and taking the time to answer their questions. They should ensure patients read and understand the fine print of informed consent forms and screen for patients who may not be suitable for LASIK surgery. Physicians also should substantiate any claim they made with the latest evidence from scientifically robust clinical studies. If an advertisement claims “90% of LASIK patients achieve 20/40 vision or better,”[19] the ophthalmologist should corroborate the claim with a reliable clinical study and ensure his outcomes do not differ significantly from the study’s outcomes. Ophthalmologists should verify they did not omit any relevant information regarding the effectiveness or nature of LASIK surgery as the omission might influence the patient’s decision to undergo surgery.[20] Any claim made in advertisements and marketing materials, whether implicitly or explicitly, must provide an accurate impression of LASIK surgery.[21] For instance, a LASIK advertisement that features a man throwing away his glasses might cause patients to believe they would be permanently free from glasses or contact lenses after LASIK surgery. Federal and global organizations, such as the Academy and the FDA should promote public awareness about LASIK’s risks and benefits and continue to regulate any promotional material that ophthalmologists use to promote LASIK surgery. The FDA should take action if an eye center in violation of the policies chooses not to comply. The Academy and the FDA should also prohibit ophthalmologists from classifying LASIK surgeries “successful” based on achieving “20/20 or 20/40 or better vision” after surgery if a complication was reported.[22]   CONCLUSION Physicians must bar misleading advertisements and fully disclose the complications of LASIK surgery to patients. Through these measures, patients would make more informed choices about whether they should undergo LASIK surgery. Rather than marketing LASIK to those with minor vision impairment or with higher risk profiles, ophthalmologists must behave according to the ethical foundation of their profession. Even with relatively few risks, doctors must be certain to minimize risk by evaluating patient eligibility for LASIK, cautioning all patients about the risks, and ensuring proper advertising and marketing practices. LASIK can give people enhanced vision expanding career and athletic opportunities and make life simpler with less need for contacts, and glasses for the right candidates. [1] Tran, Khai et al., “Laser refractive surgery for vision correction: A review of clinical effectiveness and cost-effectiveness,” CADTH Rapid Response Report: Summary with Critical Appraisal, June 22, 2018. https://www.ncbi.nlm.nih.gov/books/NBK532537. [2] Rabin, Roni, “Blurred Vision, Burning Eyes: This Is A Lasik Success?” June 11, 2018. https://www.nytimes.com/2018/06/11/well/lasik-complications-vision.html. [3] LasikComplications.com, “THE LASIK REPORT: A Call for the Discontinuation of a Harmful Procedure,” April, 2008. https://www.lasikcomplications.com/The-LASIK-Report.pdf. [4] Rabin, Roni, 2018; The Associated Press, “Witnesses Tell of Suffering after Lasik,” April 25, 2008. https://www.nytimes.com/2008/04/25/business/aplasik-web.html; Eydelman, Malvina et al., “Symptoms and satisfaction of patients in the patient-reported outcomes with laser in situ keratomileusis (PROWL) studies,” JAMA Ophthalmology 135, no. 1 (2018): 13-22; U.S. Food and Drug Administration, “What are the risks and how can I find the right doctor for me?” August 8, 2018. https://www.fda.gov/medical-devices/lasik/what-are-risks-and-how-can-i-find-right-doctor-me; American Academy of Ophthalmology, “Guidelines for refractive surgery advertising,” October 2008. https://www.aao.org/about/policies/guidelines-refractive-surgery-advertising [5] Eydelman, Malvina et al, p. 13 [6] Wilkinson, John et al., “Refractive eye surgery: Helping patients make informed decisions about LASIK,” American Family Physician 95, no. 10 (2017): 637-644 [7] Wilkinson, John, et al., p. 638 [8] Wilkinson, John, et al., p. 639 Other procedures, such as laser-assisted subepithelial keratomileusis, epithelial LASIK, femtosecond laser extraction, and small incision lenticular extraction, have been developed that have similar effectiveness as LASIK but their long-term outcomes are unknown. Some contraindications to LASIK surgery include corneal abnormalities, pregnancy, uncontrolled diabetes, uncontrolled glaucoma, and significant cataracts, and patients with abnormal wound healing, controlled diabetes, glaucoma, a history of herpetic keratitis, or systemic autoimmune disease should be cautioned before undergoing LASIK surgery. Some complications of LASIK surgery include dry eye, visual symptoms (including glare, halos, and starbursts), diffuse lamellar keratitis, and infections, with dry eye and visual symptoms accounting for 20-40 percent and 20 percent of the complications, respectively. (Wilkinson 639, 640 & 641) [9] U.S. Food and Drug Administration, 2018; American Academy of Ophthalmology, 2008 [10] American Academy of Ophthalmology, 2008 [11] U.S. Food and Drug Administration, “FDA Letter to Eye Care Professionals (May 22, 2009)” May 22, 2009. https://www.fda.gov/medical-devices/lasik/fda-letter-eye-care-professionals-may-22-2009; U.S. Food and Drug Administration, “FDA Letter to Eye Care Professionals (September 23, 2011)” September 23, 2011. https://www.fda.gov/medical-devices/lasik/fda-letter-eye-care-professionals-september-23-2011; American Academy of Ophthalmology, 2008 [12] Aubry, Allison, “Some patients say life after lasik not perfect,” May 1, 2008. https://www.npr.org/templates/story/story.php?storyId=90070220 [13] Favaro, Avis et al., “Lasik MD patients allege nerve damage, file class action lawsuit,” November 21, 2019. https://www.ctvnews.ca/health/lasik-md-patients-allege-nerve-damage-file-class-action-lawsuit-1.4697069 [14] Theophanous Christos et al., “Corneal Neuralgia after LASIK,” Optometry and Vision Science 92, no. 9 (2015): e233-e240 [15] Robin, Roni, 2018 [16] The Associated Press, 2008 [17] Canterbury v. Spence, 464 F. 2d 772 (1972) [18] Schoendorff v. Society of New York Hospital, 106 N.E.93 (N.Y. 1914)(every patient has the right to decide what is done with “his own body.”) [19] American Academy of Ophthalmology, 2008 [20] American Academy of Ophthalmology, 2008 [21] American Academy of Ophthalmology, 2008 [22] LasikComplications.com, 2008

Tsai TF, Chen PC, Lin YC et al.

Te-Fu Tsai,1,2 Po-Chun Chen,3,4 Yi-Chia Lin,1,2 Kuang-Yu Chou,1,2 Hung-En Chen,1 Chao-Yen Ho,1,5 Ji-Fan Lin,3 Thomas I-Sheng Hwang1,2,6 1Division of Urology, Department of Surgery, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 2Division of Urology, School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan; 3Central Laboratory, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; 4Department of Biotechnology, College of Health Science, Asia University, Taichung, Taiwan; 5Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 6Department of Urology, Taipei Medical University, Taipei, TaiwanCorrespondence: Thomas I-Sheng HwangDivision of Urology, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei 11102, TaiwanTel +886-2-28332211 Ext 2065Fax +886-2-28389404Email thomashwang0828@gmail.comPo-Chun Chen Email blibra1002@gmail.comPurpose: Nuclear factor (erythroid-derived 2)-like 2, also known as NFE2L2 or NRF2, a transcription factor capable of upregulating antioxidant response element (ARE)-mediated expression and cytoprotective proteins, plays critical roles in chemoprevention, inflammation and aging. NRF2 has recently been proposed as a novel target for cancer chemoprevention. The fungicide miconazole has shown promising antiproliferative effects in cancer cells.Materials and Methods: After miconazole treatment, the p62-KEAP1-NRF2 activation was analyzed by qPCR and Western blot. The nuclear translocation indicating NRF2 activation was further confirmed by immunofluorescence. Finally, the ROS production was detected by CM-H2DCFDA staining.Results: We demonstrate in this study that miconazole dramatically increases NRF2 activation in bladder cancer cells, in a dose- and time-dependent manner. Interestingly, levels of expression of p62, a noncanonical pathway that mediates NRF2 activation, appeared to increase in accordance with NRF2. We also investigated levels of the negative regulator kelch-like ECH-associated protein 1 (KEAP1), which is involved in NRF2 activation. As expected, a decrease in KEAP1 expression was found after miconazole exposure. Confirmation of NRF2 nuclear translocation was monitored by immunofluorescence. Miconazole-induced generation of reactive oxygen species (ROS) promoted NRF2 activation. Pretreatment of bladder cancer cells with ROS scavengers abolished NRF2 expression and nuclear translocation, indicating that miconazole activates the noncanonical p62-KEAP1-NRF2 pathway, which is regulated by ROS production.Conclusion: Our study elucidates the mechanisms through which miconazole stimulates NRF2 which may contribute to cancer chemopreventive effects.Keywords: miconazole, NRF2, p62, KEAP1, bladder cancer

Jeong Heo, Woo-Kie Min, Chang-Wug Oh et al.

Purpose To compare the time intervals to magnetic resonance imaging (MRI) and surgical treatment in patients having traumatic cervical spinal cord injury (SCI) with and without bony lesions. Methods Retrospectively analyzed adult patients visited Kyungpook National University Hospital and underwent surgical treatment for cervical SCI within 24 hours. The patients who were suspected of having cervical SCI underwent plain radiography and computed tomography (CT) upon arrival. After the initial evaluation, we evaluated the MRI findings to determine surgical treatment. Waiting times for MRI and surgery were evaluated. Results Thirty-four patients were included. Patients’ mean age was 57 (range, 23-80) years. Patients with definite bony lesions were classified into group A, and 10 cases were identified (fracture-dislocation, seven; fracture alone, three). Patients without bony lesions were classified into group B, and 24 cases were identified (ossification of the posterior longitudinal ligament, 16; cervical spondylotic myelopathy, eight). Mean intervals between emergency room arrival and start of MRI were 93.60 (±60.08) minutes in group A and 313.75 (±264.89) minutes in group B, and the interval was significantly shorter in group A than in group B (p=0.01). The mean times to surgery were 248.4 (±76.03) minutes in group A and 560.5 (±372.56) minutes in group B, and the difference was statistically significant (p=0.001). The American Spinal Injury Association scale at the time of arrival showed that group A had a relatively severe neurologic deficit compared with group B (p=0.046). There was no statistical significance, but it seems to be good neurological recovery, if we start treatment sooner among patients treated within 24 hours (p=0.198). Conclusions If fracture or dislocation is detected by CT, cervical SCI can be easily predicted resulting in MRI and surgical treatment being performed more rapidly. Additionally, fracture or dislocation tends to cause more severe neurological damage, so it is assumed that rapid diagnosis and treatment are possible.

Hamza Rahimi, BA, Anthony C. Venbrux, MD, Vincent Obias, MD

Enterocutaneous fistulas (ECFs) can be one of the complications found after surgical intervention for rectal cancer. Interventional modalities consisting of surgical, endoscopic, and radiological methods are often implemented to treat postoperative symptomatic complications. We present the case of 61-year-old Caucasian man who presented to us with a recent diagnosis of rectal cancer that had invaded the levators as well as anteriorly into the prostate, and who underwent low anterior resection with a diverting loop ileostomy. The patient was found to have a persistent presacral abscess due to an ECF tract. This case highlights the off-label use of ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx 34) to seal an ECF. Keywords: Rectal cancer, Embolization, Onyx