Efficacy of crystallized and liquid form phenol application in pilonidal sinus disease: a single-center retrospective study

AIM AND OBJECTIVE

Pilonidal sinus is a frequently observed disease in young adult male patients. Although its treatment is traditionally surgical, the tendency to use minimally invasive interventions has increased over time. This study aims to compare the clinical results of the non-surgical treatment methods for pilonidal sinus: crystallized and liquid phenol applications.

MATERIALS AND METHODS

We retrospectively analyzed the data of 102 patients treated with phenol application in the General Surgery Clinic of our hospital between July 2017 and July 2019. Eighty patients were included in the study: 40 treated with crystallized phenol and 40 with liquid phenol. In the 1st month following the application, the recovery rates, complication rates, persistence of complaints, and recurrence at the end of the 1st year were compared between the groups.

RESULTS

The mean age was 25.60 ± 7.16 and 25.78 ± 7.83 years in the crystallized (group 1) and liquid phenol group (group 2), respectively. Complications observed up to the 3rd week of follow-up were considered early complications, while those observed after the 3rd week were considered late complications. Early complications were observed in 15% and 37.5% of patients in groups 1 and 2, respectively (p = 0.042). Early complications were significantly higher in the liquid phenol group compared to the crystallized phenol group. At the end of the 1st year, 90% improvement was detected in group 1 and 95% in group 2. However, there was no significant difference between the recovery and recurrence rates between the groups.

CONCLUSION

In pilonidal sinus treatment, successful results are obtained with both crystallized and liquid phenol application. Both methods can be performed safely and easily as an alternative treatment method to surgery.

The role of TyG index in predicting low left ventricular ejection fraction after acute coronary syndrome

AIMS

This study aimed to investigate whether triglyceride-glucose (TyG) index and other clinical and demographic parameters are associated with left ventricular ejection fraction (LVEF) following an acute coronary syndrome (ACS) event.

METHODS & RESULTS

This retrospective cohort study included patients hospitalized with a diagnosis of ACS. The TyG index was calculated using the formula: TyG = ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. A total of 2,135 patients were included in the study (mean age: 57.49 ± 11.45 years, 78.64% male). Multivariable logistic regression revealed that mildly reduced or reduced LVEF was associated with immigrant population (p = 0.004), diabetes mellitus (p = 0.017), previous coronary artery disease (CAD) (p < 0.001), ST-elevation myocardial infarction (STEMI) (p < 0.001) and high (≥4.95) TyG index (p < 0.001). Reduced LVEF (≤40%) was independently associated with an immigrant status (p = 0.031), previous CAD (p = 0.001), peripheral artery disease (p = 0.038), renal diseases (p = 0.011), STEMI (p < 0.001) and high (≥5.10) TyG index (p < 0.001).

CONCLUSIONS

The TyG index shows potential as an independent risk factor for low LVEF after ACS.However, its relatively low sensitivity and specificity suggest that it may have a supportive role in risk stratification. Further research is needed to confirm its utility as a reliable prognostic marker for heart failure in ACS patients.

Testosterone Supplementation: A Potential Therapeutic Strategy for Amyotrophic Lateral Sclerosis

Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal disease characterized by the degeneration of spinal cord and brain neurons. Proteomics combined with Mendelian randomization (MR) is an effective method for finding disease treatment targets. Methods: We aimed to seek new therapeutic targets for ALS. A large-scale GWAS on proteomics (4907 circulatory protein) with 35,559 individuals was included as the exposure data; a GWAS with 138,086 ALS patients was used as the outcome data; we found that a high level of sex hormone-binding globulin (SHBG) is a risk factor by MR analysis. Colocalization analyses were used to validate the causality between SHBG and ALS further. Functional enrichment found a high level of SHBG was associated with a low level of bioavailable testosterone. Two-sample MR confirmed the association of SHBG (400,210 samples), bioavailable testosterone (367,289 samples), and ALS. Results: A high level of SHBG, and a low level of bioavailable testosterone are risk factors for ALS. Conclusions: A low level of bioavailable testosterone is a risk factor for ALS. Although our study is relatively limited and cannot fully confirm that testosterone supplementation has a therapeutic effect on ALS, it offers a promising direction for ALS therapy.

An open-label Phase 2a study to assess the safety and tolerability of trimetazidine in patients with amyotrophic lateral sclerosis

Metabolic imbalance is associated with amyotrophic lateral sclerosis progression. Impaired glucose oxidation and increased reliance on fatty acid oxidation contribute to reduced metabolic flexibility and faster disease progression in amyotrophic lateral sclerosis. We sought to evaluate the safety and tolerability, and explore the pharmacodynamic response of trimetazidine, a partial fatty acid oxidation inhibitor, on oxidative stress markers and energy expenditure in amyotrophic lateral sclerosis. The study was conducted between June 29, 2021 and May 24, 2023. People living with amyotrophic lateral sclerosis, recruited in Australia and the Netherlands, received open-label oral trimetazidine for 12 weeks after an initial 4-week lead-in period. The primary outcome measures were safety and tolerability, as well as the change from baseline in oxidative stress markers malondialdehyde (MDA) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). Secondary outcome measures were change from baseline in energy expenditure, amyotrophic lateral sclerosis functional rating scale-revised, and slow vital capacity (SVC). Linear mixed effects were used to estimate the mean difference in MDA and 8-OHdG between the on- and off-treatment periods. This trial is registered under ClinicalTrial.gov National Clinical Trial (NCT) number NCT04788745 and European Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2020-005018-17. Twenty-one participants received trimetazidine; 19 (90%) completed the treatment period. Trimetazidine was well tolerated; there were 57 adverse events reported, of which 7 (11%) were deemed potentially drug-related, including hot flushes (2), nausea (2), paraesthesia (2) and fatigue (1). MDA was numerically lower during treatment [-0.29 uM; 95% confidence interval (CI) -0.90 to 0.33, P  = 0.36]; 8-OHdG was significantly lower during treatment (-0.12 nM; 95% CI -0.23 to -0.01, P = 0.0245). The decrease in oxidative stress markers was accompanied by a reduction in resting energy expenditure (95 kcal, 95% CI 36.8-154, P = 0.0014). The absence of a placebo group prevented the interpretation of the clinical parameters. Oral trimetazidine was safe and well tolerated among patients with amyotrophic lateral sclerosis. This, combined with the significant reduction in markers of oxidative stress and resting energy expenditure, warrants a larger double-blind placebo-controlled efficacy study.

Histopathological Analysis Post Sleeve Gastrectomy: Value and Correlation With Preoperative Endoscopic Findings

Background Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgical procedures performed today. Before LSG, patients undergo an endoscopic examination to assess for any significant pathology that could affect the surgical outcome. Following LSG, the resected stomach tissue is routinely submitted for histopathological analysis, though the practice's efficacy remains debated. Furthermore, formal guidelines and recommendations for this practice are lacking. Methodology This retrospective single-center analysis was conducted at King Fahad Specialist Hospital (KFSH) in Buraydah, Al-Qassim. Following ethical approval, all patients with obesity who underwent LSG at our institution between 2017 and 2024 and whose medical records contained complete data were included in this study. Patient data meeting the inclusion criteria were then collected through a review of medical records. Data were collected using a standardized collection sheet. Results This study included 908 patients with obesity. Of the 908 patients, 547 (60.2%) were female and 361 (39.8%) were male. The vast majority, 893 (98.3%), were Saudi nationals. Participants had a mean age of 35.16 ± 13.049 years and a mean BMI of 44.08 ± 7.095 kg/m2. Preoperative gastroscopy revealed no mucosal abnormalities, ulcers, polyps, or vascular lesions in 421 patients (99.3%). Histopathological examination (HPE) of the resected tissue identified premalignant lesions in three patients (0.7%), with no malignancies detected. Conclusions This study highlights the value of HPE and its correlation with preoperative endoscopic findings in patients undergoing LSG. Given the low prevalence of malignancy, routine HPE may not be warranted. Therefore, HPE should be considered selectively to reduce costs and effort.

Gender-specific outcomes in pilonidal sinus disease: Female outcomes after cleft lift surgery in a large prospective Danish cohort

AIM

Pilonidal sinus disease (PSD) is a common condition particularly affecting young men. Females affected by the condition account for about 20% of patients and are rarely mentioned, much less studied specifically. In this study we evaluate the surgical outcomes in a female population following Bascom's cleft lift (BCL) surgery in primary extensive disease, non-healing wounds after previous surgery and recurrent disease in a large Danish cohort from a high-volume centre.

METHOD

The study is based on a prospective database established at Randers Regional Hospital in 2016. All patients undergoing BCL surgery from June 2016 until October 2022 were included in this study.

RESULTS

In all, 560 patients underwent BCL surgery at our centre during this period. Eighty-eight (15.7%) were women. Only 10 (11.3%) were operated due to primary extensive manifestations. The rest presented with either non-healing wounds after previous surgery (47.7%) or recurrent PSD (41%). Risk of recurrence in female patients was 30% higher than in male patients (risk ratio 1.30, 95% CI 0.79-2.09) and the risk of prolonged healing after BCL surgery was 46% higher in women compared to men (risk ratio 1.46, 95% CI 1.02-2.14).

CONCLUSION

Female PSD patients may represent a subcategory of patients at higher risk of treatment failure and should be dealt with as such. Initially, few present with the need for extensive surgery. However, given the common occurrence of prolonged healing and recurrence, we recommend a minimal invasive approach when possible.

Irisin in thyroid diseases

Irisin, a hormone-like adipo-myokine, has garnered considerable attention in recent years for its potential impact in metabolic diseases. Its physiological effects are similar to those of thyroid hormones, prompting numerous investigations into potential correlations and interactions between irisin and thyroid function through various in vitro and animal experiments. However, existing studies suggest that the relationship between irisin and thyroid diseases is highly complex and multifaceted. In this paper, we have summarized the research results on serum irisin and thyroid function, providing an overview of advancements and constraints in current research on irisin and thyroid hormones. The aim is to offer insights and directions for future clinical trials in this field.

Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial

OBJECTIVE

This study aims to evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease (PSD).

METHODS

A single-center randomized controlled trial was conducted at Istanbul Esenyurt Hospital. Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45). Upon arrival at the clinic, patients began a regimen of manual shaving and, if necessary, laser epilation every 6-8 weeks. For those with pilonidal abscesses, incision, drainage, and antibiotics were given. The treatment area was sterilized and numbed with local anesthesia. Hair removal and curettage were performed, followed by the application of crystallized phenol. In CP + PRP group, PRP injections were also administered. The procedure concluded with wound dressing and thorough disinfection. The study was registered https://clinicaltrials.gov/ (NCT06324656).

RESULTS

The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001). The cosmetic score was higher in the CP + PRP group (7.42 ± 1.61) than in the CP group (6.11 ± 1.88, p = 0.001). CP + PRP group had lower VAS scores at measured all-time points after applications (p < 0.05 for each). Complications were comparable between the groups, with no significant differences in bleeding, infections, or skin burns (p > 0.05 for each comparison). No difference was found between groups in terms of total complication rate (p = 0.398). The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039). Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039).

CONCLUSION

The autologous PRP injection in pediatric PSD is safe. The addition of PRP to CP treatment for pediatric PSD significantly improves healing time, cosmetic outcomes, and overall success rates without increasing complication rates. This combined approach offers a promising alternative for effective and efficient treatment of PSD in children.

TYPE OF THE STUDY

Randomized controlled trial.

LEVEL OF EVIDENCE

Level I.

Short-term results of unroofing and marsupialization compared to the Karydakis technique in the treatment of pilonidal sinus. A randomized prospective study

INTRODUCTION

The treatment of pilonidal sinus (PS) is usually surgical, but no procedure is considered the gold standard. The Karydakis (K) technique is widely used, and unroofing and marsupialization (UM) is a simple surgery with good results.

PRIMARY OBJECTIVE

To evaluate early postoperative complications (EPC) 30 days after UM surgery compared to the K technique.

SECONDARY OBJECTIVES

To evaluate surgical time, postoperative pain, patient satisfaction, return to daily activity and early recurrence within 3 months.

METHOD

Prospective, single-center, randomized study in patients who underwent surgery for primary PS with no abscess between June 2016 and November 2017. They were randomized using a computer-generated block method. To analyze the main objective, a non-inferiority analysis was performed.

RESULTS

122 patients with symptomatic primary PS were randomized: 60 in the K group and 62 in the UM group. Both groups were homogeneous. There were statistically significant differences between surgery and postoperative complications at 15 and 30 days in favor of UM. There were also differences in favor of UM in surgical time and return to daily activity. During the 90-day follow-up, there were 3 recurrences in the UM group and 0 in the K group.

CONCLUSIONS

UM is a simple, minimally invasive, easily reproducible technique that has a lower rate of early complications, with a shorter operative time and an earlier return to daily activity.

Active Helicobacter pylori Infection Does Not Influence Outcomes After Sleeve Gastrectomy-Observational Cohort Study

Background: Helicobacter pylori (HP) is under investigation for its potential role in postoperative complications. While some studies indicate no impact, they often cite short or incomplete follow-up. This study aims to compare 1-year outcomes in groups with and without active HP infection after bariatric surgery, also assessing HP prevalence in postoperative specimens of sleeve gastrectomy (SG) patients. Methods: Conducted between May 2020 and May 2021, this study involves both retrospective and prospective data collection from 93 eligible SG patients. Demographics, surgical outcomes and follow-up results (including complications; weight and BMI at 3, 6 and 12 months post-SG) were extracted. Results: No statistically significant differences in body weight were observed at 3 (p = 0.3757), 6 (p = 0.1422) or 12 (p = 0.2737) months post-surgery between the HP-positive (Group A) and non-infected (Group B) groups. Group A experienced significant reductions in body weight at 6 and 12 months (p < 0.0001), while group B showed significant reductions at 3, 6 and 12 months (p < 0.0001), with additional decreases at 6 and 12 months post-surgery compared to 3 months. No significant differences in overall surgery-related side effects were observed between the groups. Conclusions: Patients with active HP infections undergoing SG displayed comparable rates of short- and long-term complications to the non-infected group. Active HP infection did not impact body weight loss outcomes at 12 months, but it may potentially slow it down in the initial three-month post-surgery period. This underscores the need to consider eradication while maintaining awareness of the potential side effects associated with the process.

New insights on pharmacological and therapeutic potentials of trimetazidine beyond anti-anginal drug: A comprehensive review

Trimetazidine (TMZ) is a beneficial and well-tolerable anti-anginal drug which has protective action towards ischemia and reperfusion injury. TMZ performs its anti-ischemic effect by modifying cardiac metabolism without shifting the hemodynamic functions, so it represents an outstanding complementary perspective to the general angina treatment. TMZ possesses a positive impact on the inflammatory profile, and also endothelial function furthermore displays various benefits through minimising the number, as well as the intensity of angina strikes and ameliorating the clinical indication and symptoms of myocardium ischemia. It is administrated as monotherapy along with a combination of different antianginal drugs. Apart from anti-angina action, in recent years TMZ has shown various pharmacological activities such as neuroprotective, renal protective, hepato-protective, cardio-protective effects, and other beneficial pharmacological activities. We select to write the present review article to cover the different pharmacological and therapeutic potentials of TMZ.

FNDC5 affects invasion and migration of oral cancer by inhibiting PI3K/Akt/Snail signaling pathway

This study first investigated how FNDC5 affected the development of oral cancer and revealed the role of FNDC5 in the migration and invasion of oral cancer. The present work evaluated differential FNDC5 expression within oral cancer samples versus matched non-carcinoma samples based on GEO database analysis and immunohistochemistry. We then generated oral cancer cell lines with FNDC5 overexpression and knockdown to determine the role of altered FNDC5 expression in the migration and invasion of oral cancer. PI3K inhibitor was used for investigating the possible mechanism underlying FNDC5 during EMT of oral cancer. Finally, these in-vitro results were validated using the lung metastatic nude mouse model. According to our results, FNDC5 level markedly decreased within oral cancer compared with adjacent samples and FNDC5 overexpression inhibited migration, invasion as well as EMT of oral cancer, while FNDC5 knockdown promoted oral cancer cell EMT. In addition, PI3K inhibitors blocked the induction of oral cancer cells EMT by FNDC5 knockdown. In vivo experiments further demonstrated the above results. This work is the first to illustrate the impact of FNDC5 on inhibiting migration and invasion of oral cancer, and our results suggest that FNDC5 affects EMT of oral cancer via the inhibition of PI3K/Akt/Snail pathway.

Role of spexin and DARS2 as potential biomarkers in basal cell carcinoma and cutaneous malignant melanoma diagnosis, and as therapeutic targets

Basal cell carcinoma (BCC) is a slowly progressive, locally aggressive and rarely metastasizing cancer, and although its mortality is low, its morbidity and cost of disease are high. While BCC is more common, cutaneous malignant melanoma (CMM) is significant due to its higher mortality rate. These patients can be treated, but recurrence, metastasis and mortality may occur in such patients. Various environmental, phenotypic and genotypic factors, especially ultraviolet (UV) radiations, play a role in the etiology of BCC and CMM. Histopathological examination continues to be the "gold standard" in their diagnosis. Spexin (SPX) and DARS2 are newly discovered proteins linked to many diseases, including cancer. These proteins may have an effect on the development and expression of skin cancers such as BCC and CMM. In this study, we evaluated the potential of SPX and DARS2 expressions as immunohistochemical biomarkers in the differential diagnosis of BCC and CMM. This study was conducted retrospectively using samples taken from the pathology laboratory. A total of 180 patient samples were used. The control group consisted of healthy skin tissues of the patients, and the other groups consisted of BCC and CMM tissues of the same patients. Tissue samples of all three groups were evaluated immunohistochemically with SPX and DARS2. The immunoreactivity of SPX was found to be higher in BCC and CMM tissue samples than in healthy skin tissues in the control group. DARS2 immunoreactivity was found to be higher in CMM tissues compared to the other two groups, and statistically significant in BCC tissues when compared with healthy control group tissues. SPX can be used as an immunohistochemical biomarker in the diagnosis of BCC and CMM. Since DARS2 expression is statistically more significant in CMM tissues than in BCC tissues, it can be used in differential diagnosis.

Results of Laser-assisted Closure (SiLaC) Surgery in Pilonidal Sinus Disease: Factors Associated With Success

BACKGROUND

Pilonidal sinus treatment with sinus laser-assisted closure (SiLaC) method has produced promising results in a limited number of studies conducted in recent years. We aimed to examine the efficacy and safety of this method in a tertiary care training hospital to reveal the factors affecting failure and to share our first experiences.

METHODS

All adult patients treated with this procedure between March 2020 and December 2023 were included in the study. Demographic and clinical data, complications, and recurrence rates of the patients were compared. Univariate analysis was performed between recovered and non-recovered patients to find the factors influencing successful treatment. Logistic regression analysis was performed using significant factors in the single variable analysis.

RESULTS

The study cohort consisted of 64 patients. The mean follow-up period was 17.0±8.06 months (range: 3 to 36), and the mean time for return to work was 2.4±2.78 days (range: 0 to 14). Our recovery rate was 85.9%. The complication rate was 14%, and the majority (50%) were wound infections. High BMI and advanced disease were significant factors for recurrence in the comparison of patients with successful and unsuccessful treatment ( P <0.01 and 0.013, respectively). The same situation persisted in multivariate analysis ( P =0.026, 95% CI: 1.36-7.81, and P =0.004, 95% CI: 1.36-1.78, respectively). In the ROC Curve analysis for BMI, the cutoff point was 29 (sensitivity: 66.9%, specificity: 77.4%, AUC 0.809). Other parameters were not significant ( P >0.05).

CONCLUSIONS

The SiLaC procedure may be the treatment of choice for pilonidal sinus disease as a safe and effective method with mild complications and reasonable recurrence rates. The success rate decreased in obese patients and patients with advanced disease.

Effect of Flaxseed on Pain Relief and Quality of Life in Patients With Mastalgia: A Single Arm Interventional Study

Objective

Mastalgia, a common complaint among women, denotes breast discomfort that can manifest as cyclical or non-cyclical. Reassurance, mechanical support and various non-pharmacological treatments, like flaxseeds, have been seen to have a good effect in treating mastalgia. Thus, the aim of this study was to investigates the efficacy of flaxseed in alleviating pain associated with mastalgia and its impact on the overall health-related quality of life among female patients.

Materials and Methods

Conducted at a tertiary care center in Northern India over 18 months, it employed a single-arm interventional design. The participants included females aged 18 years and older presenting with breast pain at the Department of General Surgery. The intervention involved daily consumption of 30 g of milled flaxseed for each participant, administered over a period of six months. Pain severity was assessed using the visual analogue scale (VAS) before supplementation and at follow-up intervals up to six months. Concurrently, the Short Form-12 (SF-12) items Health Survey measured health-related quality of life, encompassing both physical and mental health domains. Statistical analysis employed parametric (paired t-test) and non-parametric tests (chi-square, McNemar) where appropriate, with statistical significance set at p<0.05.

Results

Two hundred women with mastalgia were included with a significant reduction in mean VAS scores from 6.03±0.83 at baseline to 2.19±0.66 at six months post-intervention (p = 0.0001). This reduction in pain intensity demonstrated a positive correlation with duration of flaxseed supplementation, notably declining after the initial three months. The mean difference in physical and mental SF-12 score at first visit and at 6 months after intervention was significant (p = 0.0001).

Conclusion

This study underscores the potential of flaxseed as a therapeutic option for managing mastalgia and enhancing health-related quality of life among affected individuals.

Genome-Wide Association Study Identifies Genes for Hair Growth and Patterning are Associated With Pilonidal Disease

BACKGROUND

Pilonidal sinus disease is a highly morbid condition characterized by the formation of chronic sinus tracts throughout the sacrococcygeal region. Despite its commonality and strong association with family history, no prior investigation of genetic risk factors for pilonidal sinus disease exists.

OBJECTIVE

To identify genetic risk factors for pilonidal sinus disease.

DESIGN

A genome-wide association study.

SETTINGS

The United Kingdom Biobank, FinnGen Biobank, and Penn Medicine BioBank.

PATIENTS

There were 772,072 participants.

MAIN OUTCOME MEASURE

Genome-wide significant variants ( p < 5 × 10 -8 ) were mapped to genes using physical distance and gene expression in skin. Genetic correlation between pilonidal sinus disease and morphometric, androgen-driven, and hair phenotypes was estimated with linkage disequilibrium score regression. Finally, a genome-first approach to rare predicted deleterious variants in hair shaft genes TCHH , PADI3 , and TGM3 was conducted for association with pilonidal sinus disease via the Penn Medicine BioBank.

RESULTS

A genome-wide association study comprising 2835 individuals with pilonidal sinus disease identified 5 genome-wide significant loci, prioritizing HDAC9, TBX15, WARS2, RP11-293M10.1 , PRKAR1B , TWIST1, GPATCH2L, NEK9 , and EIF2B2 , as putative causal genes; several of these genes have known roles in balding and hair patterning. There was a significant correlation between the genetic background of pilonidal sinus disease and the androgen-driven hair traits of male pattern baldness and young age at first facial hair. In a candidate analysis of genes associated with syndromic hair disorders, rare coding variants in TCHH , a monogenic cause of uncombable hair syndrome, were associated with increased prevalence of pilonidal sinus disease (OR 4.81 [95% CI, 2.06-11.2]).

LIMITATIONS

This study is limited to European ancestry. However, because there is a higher incidence of pilonidal sinus disease in men of European ancestry, this analysis is focused on the at-risk population.

CONCLUSIONS

Genetic analysis of pilonidal sinus disease identified shared genetic architecture with hair biology and androgen-driven traits. As the first study investigating the genetic basis of pilonidal sinus disease, this provides biological insight into the long-appreciated connection between the disease state, male sex, and hair. See Video abstract.

UN ESTUDIO DE ASOCIACIN DEL GENOMA COMPLETO IDENTIFICA GENES DEL CRECIMIENTO Y EL PATRN DEL PELO ASOCIADOS A LA ENFERMEDAD PILONIDAL

ANTECEDENTES:La enfermedad del seno pilonidal es una condición muy mórbida caracterizada por la formación de tractos sinusales crónicos en toda la región sacrococcígea. A pesar de su frecuencia y su fuerte asociación con los antecedentes familiares, no se han investigado previamente los factores de riesgo genéticos de la enfermedad sinusal pilonidal.OBJETIVO:Identificar factores genéticos de riesgo para la enfermedad del seno pilonidal.DISEÑO:Estudio de asociación de genoma completo.CONJUNTOS:Biobanco del Reino Unido, Biobanco FinnGen y Biobanco PennMedicine.PACIENTES:772.072 participantes.MEDIDA DE RESULTADO PRINCIPAL:Las variantes significativas en todo el genoma (p < 5x10-8) se asignaron a genes utilizando la distancia física y la expresión génica en la piel. La correlación genética entre la enfermedad del seno pilonidal y los fenotipos morfométricos, androgénicos y de cabello se estimó con regresión de puntuación LD. Por último, se realizó una aproximación genómica a variantes deletéreas raras predichas en los genes del tallo piloso TCHH, PADI3 y TGM3 para su asociación con la enfermedad del seno pilonidal a través del Biobanco PennMedicine.RESULTADOS:El estudio de asociación de todo el genoma, que incluyó a 2.835 individuos con enfermedad del seno pilonidal, identificó 5 loci significativos en todo el genoma, dando prioridad a HDAC9, TBX15, WARS2, RP11-293M10.1, PRKAR1B, TWIST1, GPATCH2L, NEK9 y EIF2B2, como genes causales putativos; varios de estos genes tienen funciones conocidas en la calvicie y el patrón del cabello. Se observó una correlación significativa entre los antecedentes genéticos de la enfermedad del seno pilonidal y los de los rasgos calvicie de patrón masculino y edad temprana del primer vello facial impulsados por andrógenos. En un análisis de genes candidatos asociados a trastornos capilares sindrómicos, las variantes raras de codificación en TCHH, una causa monogénica del síndrome capilar incombustible, se asociaron a una mayor prevalencia de la enfermedad del seno pilonidal (OR 4,81 [IC del 5%, 2,06-11,2]).LIMITACIONES:Este estudio se limita a la ascendencia europea. Sin embargo, debido a que hay una mayor incidencia de la enfermedad sinusal pilonidal en los hombres de ascendencia europea, este análisis se centra en la población de riesgo.CONCLUSIÓN:El análisis genético de la enfermedad del seno pilonidal identificó una arquitectura genética compartida con la biología del cabello y los rasgos impulsados por andrógenos. Siendo el primer estudio que investiga las bases genéticas de la enfermedad del seno pilonidal, esto proporciona una visión biológica de la conexión, apreciada desde hace tiempo, entre el estado de la enfermedad, el sexo masculino y el cabello. (Traducción-Dr. Aurian Garcia Gonzalez ).

The association of cortisol, testosterone, and cortisol/testosterone ratio with stroke: A cross-sectional study

AIMS

We aimed to investigate the association between serum cortisol, testosterone, and cortisol/testosterone (C/T) ratio and stroke.

MATERIALS AND METHODS

A total of 6157 subjects were included in this study. The serum levels of cortisol and testosterone were determined by liquid chromatography-tandem mass spectrometry method. The relationships of serum cortisol, testosterone, and C/T ratio levels with the odds ratios (ORs) of stroke were calculated using logistic regression analysis. The dose-response associations between serum cortisol, testosterone, and C/T ratio levels with stroke estimated by restricted cubic splines.

RESULTS

After adjusting for multiple variables, serum testosterone levels were negactively associated with stroke in males (per 1 unit, odds ratio (OR) = 0.83, 95 % confidence interval (CI): 0.70, 0.97). The serum C/T ratio is positively associated with stroke in both males and females (OR = 1.16, 95 % CI:1.04,1.34 in males and OR = 1.15, 95 % CI:1.02,1.31 in females). Restricted cubic splines showed a significant linear dose-response relationship between testosterone and C/T ratio and stroke in males (P for overall association <0.05, P for nonlinearity >0.05).

CONCLUSION

Our study findings show that serum testosterone levels are negatively correlated with stroke in males; meanwhile, serum C/T ratio is positively correlated with stroke in both males and females.

Advancements in Surgical Approaches for Sacrococcygeal Pilonidal Sinus: A Comprehensive Review

Sacrococcygeal pilonidal sinus (SPS) is a condition involving the formation of a cavity in the lower back region. It is more common among young adults and is influenced by factors such as sitting for long periods, body hair, and certain lifestyle habits. Surgical treatment is often necessary for recurring or severe cases, and various surgical techniques available, ranging from traditional surgical methods to newer, less invasive approaches. This comprehensive review examines the progress in surgical techniques for managing SPS, emphasizing the effectiveness, safety, and patient outcomes associated with different methods. It provides an overview of traditional procedures, such as excision with primary closure, and contrasts these with recent innovations like endoscopic and laser-assisted techniques. The review also considers advanced technologies, including the potential of robotic surgery and the use of specialized materials. By assessing clinical outcomes, recurrence rates, complications, and patient satisfaction, this review seeks to identify the most effective surgical strategies for SPS. Additionally, it discusses recent technological advancements and highlights areas needing further research to improve the management and treatment of this condition.

Heterogeneity of Treatment Effects of Laser Epilation on Pilonidal Disease Recurrence: A Randomized Clinical Trial

Objective

To investigate the heterogeneity of treatment effects (HTE) of laser epilation in preventing pilonidal disease recurrence through analysis of prespecified clinical factors.

Background

Pilonidal disease is a common, painful disease affecting 1% of the population aged 15 to 30 years with postoperative recurrence rates as high as 30% to 40%.

Methods

Single-institution randomized controlled trial from September 2017 to September 2022 with 1-year follow-up, including patients aged 11 to 21 years with pilonidal disease undergoing gluteal cleft laser epilation and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone.

Results

In total, 302 patients were enrolled with 151 randomized to each intervention. 1-year follow-up was available for 96 patients in the laser group and 134 in the standard care group. There were no significant differences in treatment effects based on sex, body mass index, previous disease, prior surgical excision, or annual household income (all P > 0.05). HTE was identified by race and ethnicity (P = 0.005) and health insurance type (P = 0.001). Recurrence among non-Hispanic white patients was 4% (3/75) with laser treatment and 31.6% (31/98) with standard care versus 38.9% (7/18) with laser treatment and 38.2% (13/34) with standard care among all other racial/ethnic groups. Recurrence rates among privately insured patients were 4.0% (3/75) with laser treatment and 33.3% (29/87) with standard care versus 36.8% (7/19) with laser treatment and 29.7% (11/37) with standard care in patients with public insurance.

Conclusions

The effectiveness of laser epilation to reduce pilonidal disease recurrence rates may vary based on race and ethnicity and insurance type. Additional studies are warranted to investigate this potential HTE.

Adolescent pilonidal disease laser treatment (a-PiLaT): a pilot study

BACKGROUND

Pilonidal disease (PD) is an acquired condition related to hair-induced mechanical forces on the skin surface of the intergluteal cleft, with subsequent abscess formation with or without a concomitant draining sinus (pit). While surgical management currently is the mainstay of treatment, pilonidal disease laser treatment (PiLaT) has recently been recognized as a promising treatment option for non-inflammatory diseases. Nonetheless, there is a paucity of available data on adolescent pilonidal disease laser treatment (a-PiLaT).

METHODS

We describe our preliminary experience with PiLaT performed in adolescents aged 10-17 years at our tertiary paediatric surgical hospital from 2019 to 2023. Data on perioperative characteristics and clinical outcomes at follow-up were retrospectively analysed.

RESULTS

A total of 17 consecutive patients (n = 12 female, 71%) underwent a-PiLaT. At the time of treatment, the patients' mean age and body mass index were 13.6 ± 1.6 years and 25.3 ± 5.6 kg m-2, respectively. The mean operative time was 21.5 ± 10.4 min, whereas the mean follow-up period was 24.5 ± 16.8 months, with a complication rate of 24% (n = 4) and recurrence rate of 18% (n = 3). With respect to postsurgical scar assessment, the mean Patient and Observer Scar Assessment Scale scores (score range 6-60, with higher scores indicating worse outcome) were 14.2 ± 6.5 (patients' evaluation) and 11.4 ± 4.7 (observers' evaluation).

CONCLUSION

The a-PiLaT represents a novel approach for managing PD in adolescents. Our preliminary data on the outcomes of a small series of patients with pilonidal sinuses after a-PiLaT indicated complication and recurrence rates comparable to those reported in the literature for adults. This new minimally invasive technique has great potential and is therefore worthy of further research on a larger population.

Effects of E4/DRSP on self-reported physical and emotional premenstrual and menstrual symptoms: data from the phase 3 clinical trial in Europe and Russia

PURPOSE

To describe the effects of estetrol (E4) 15 mg/drospirenone (DRSP) 3 mg on physical and emotional premenstrual and menstrual symptoms.

MATERIALS AND METHODS

We used Menstrual Distress Questionnaire (MDQ) data from a phase-3 trial (NCT02817828) in Europe and Russia with participants (18 - 50 years) using E4/DRSP for up to 13 cycles. We assessed mean changes in MDQ-t-scores from baseline to end of treatment in premenstrual (4 days before most recent flow) and menstrual (most recent flow) scores for 4 MDQ domains in starters and switchers (use of hormonal contraception in prior 3 months) and performed a shift analysis on individual symptoms within each domain.

RESULTS

Of 1,553 treated participants, 1,398(90.0%), including 531(38%) starters, completed both MDQs. Starters reported improvements for premenstrual Pain (-1.4), Water Retention (-3.3) and Negative Affect (-2.5); and for menstrual Pain (-3.5), Water Retention (-3.4), and Negative Affect (-2.7) (all p < 0.01). For switchers, no changes were significant except an increase in premenstrual (+1.0, p = 0.02) and menstrual (+1.5, p = 0.003) Water Retention. We observed a change in symptom intensity in >40% of participants for Cramps, Backache and Fatigue (domain Pain), Painful or Tender Breast and Swelling (domain Water Retention) and Mood Swings and Irritability (domain Negative Affect).

CONCLUSION

E4/DRSP starters experienced significant improvements in the domains Pain, Water Retention and Negative Affect particularly benefiting those with more severe baseline symptoms. Switchers showed minimal changes.

Evaluating Sex Steroid Hormone Neuroprotection in Spinal Cord Injury in Animal Models: Is It Promising in the Clinic?

The primary mechanism of traumatic spinal cord injury (SCI) comprises the initial mechanical trauma due to the transmission of energy to the spinal cord, subsequent deformity, and persistent compression. The secondary mechanism of injury, which involves structures that remained undamaged after the initial trauma, triggers alterations in microvascular perfusion, the liberation of free radicals and neurotransmitters, lipid peroxidation, alteration in ionic concentrations, and the consequent cell death by necrosis and apoptosis. Research in the treatment of SCI has sought to develop early therapeutic interventions that mitigate the effects of these pathophysiological mechanisms. Clinical and experimental evidence has demonstrated the therapeutic benefits of sex-steroid hormone administration after traumatic brain injury and SCI. The administration of estradiol, progesterone, and testosterone has been associated with neuroprotective effects, better neurological recovery, and decreased mortality after SCI. This review evaluated evidence supporting hormone-related neuroprotection over SCI and the possible underlying mechanisms in animal models. As neuroprotection has been associated with signaling pathways, the effects of these hormones are observed on astrocytes and microglia, modulating the inflammatory response, cerebral blood flow, and metabolism, mediating glutamate excitotoxicity, and their antioxidant effects. Based on the current evidence, it is essential to analyze the benefit of sex steroid hormone therapy in the clinical management of patients with SCI.

Combinatorial Inhibition of Complement Factor D and BCL2 for Early-Onset Colorectal Cancer

BACKGROUND

The tumor immune microenvironment is distinct between early-onset and late-onset colorectal cancer, which facilitates tumor progression. We previously identified several genes, including complement factor D, as having increased expression in patients with early-onset colorectal cancer.

OBJECTIVE

This study aimed to assess and validate the differential expression of immune genes in early-onset and late-onset colorectal cancer. We also aimed to test known drugs targeting genes increased in early-onset colorectal cancer in preclinical mouse models.

DESIGN

A retrospective cohort study with analysis was performed using tumor RNA from formalin-fixed paraffin-embedded cell culture and immunohistochemistry to validate gene expression and function and in vivo preclinical tumor study to assess drug efficacy.

SETTINGS

The Oregon Colorectal Cancer Registry was queried to identify patients with colorectal cancer.

PATIENTS

The study included 67 patients with early-onset colorectal cancer and 54 patients with late-onset colorectal cancer.

INTERVENTIONS

Preclinical animal models using the HCT-116 colon cancer cell line were treated with the complement factor D inhibitor danicopan and the BCL2 inhibitor venetoclax, or with vehicle controls.

MAIN OUTCOME MEASURES

Elevated RNA signatures using NanoString data were evaluated by the retrospective cohort. When inhibiting these markers in the mouse preclinical model, tumor volume and weight were the main outcome measures.

RESULTS

After updating our sample size from our previously published data, we found that complement factor D and BCL2, genes with known function and small molecule inhibitors, are elevated in patients with early-onset colorectal cancer. When inhibiting these markers with the drugs danicopan and venetoclax in a mouse model, we found that the combination of these drugs decreased tumor burden but also resulted in toxicity.

LIMITATIONS

This study is limited by a small sample size and a subcutaneous tumor model.

CONCLUSIONS

Combinatorial inhibition of early-onset associated genes complement factor D and BCL2 slows the growth of early-onset colorectal cancer in a mouse preclinical model. See Video Abstract .

INHIBICIN COMBINADA DEL FACTOR DCOMPLEMENTARIO Y DEL BCL EN CASOS DE CNCER COLORRECTAL DE APARICIN TEMPRANA

ANTECEDENTES:El microambiente inmunológico del tumor es distinto entre el cáncer colorrectal de aparición temprana y el de aparición tardía, lo que facilita la progresión de dicho tumor. Anteriormente identificamos varios genes, incluidos el factor D-Complementario, con una mayor expresión en pacientes con cáncer colorrectal de aparición temprana.OBJETIVO:El presente estudio tuvo como objetivo el evaluar y validar la expresión diferenciada de genes inmunes en casos de cáncer colorrectal de aparición temprana y tardía. También nos propusimos evaluar los fármacos conocidos dirigidos sobre los genes aumentados en el cáncer colorrectal de aparición temprana en modelos pre-clínicos en ratones.DISEÑO:Estudio de cohortes con análisis retrospectivo utilizando el ARN tumoral procedente de cultivos celulares fijados con formalina e incluidos en parafina, y el analisis por inmunohistoquímica para validar la expresión y la función genética. Se realizó el estudio pre-clínico de los tumores in vivo para evaluar la eficacia de los fármacos.AJUSTES:Se consultó el Registro de Oregon de casos de Cáncer Colorrectal para encontrar los pacientes afectados.SUJETOS:67 pacientes con cáncer colorrectal de aparición temprana y 54 pacientes con cáncer colorrectal de aparición tardía.INTERVENCIONES (SI LAS HUBIESE):Los modelos animales pre-clínicos que utilizaron la línea celular de cáncer de colon HCT-116 se trataron con el inhibidor del factor D-Complementario o Danicopan y con el inhibidor de BCL-2 o Venetoclax, ambos con control del transportador.PRINCIPALES MEDIDAS DE RESULTADO:Se evaluaron las firmas de ARN elevadas utilizando los datos del NanoString a partir de la cohorte retrospectiva. Al inhibir estos marcadores del modelo pre-clínico en los ratones, el volumen y el peso del tumor fueron las principales medidas de resultado.RESULTADOS:Después de actualizar el tamaño de nuestra muestra a partir de datos publicados con anterioridad, encontramos que el factor D-Complementario y BCL-2, genes con función conocida e inhibidores de moléculas pequeñas, se encuentran elevados en aquellos pacientes con cáncer colorrectal de aparición temprana. Al inhibir estos marcadores con los medicamentos Danicopan y Venetoclax en el modelo de ratones vivos, encontramos que la combinación de estos dos farmacos disminuyó la carga tumoral pero también produjo toxicidad.LIMITACIONES:Estudio limitado por un tamaño de muestra pequeño y el modelo de tumor subcutáneo.CONCLUSIONES:La inhibición combinada de genes asociados de aparición temprana, el factor D-Complementario y el BCL-2, enlentecen el crecimiento del cáncer colorrectal de aparición temprana del modelo preclínico en ratones. (Traducción-Dr. Xavier Delgadillo ).

Pinocembrin's protective effect against acute pancreatitis in a rat model: The correlation between TLR4/NF-κB/NLRP3 and miR-34a-5p/SIRT1/Nrf2/HO-1 pathways

BACKGROUND

Acute pancreatitis (APS) is a prevalent acute pancreatic inflammation, where oxidative stress, inflammatory signaling pathways, and apoptosis activation contribute to pancreatic injury.

METHODS

Pinocembrin, the predominant flavonoid in propolis, was explored for its likely shielding effect against APS provoked by two intraperitoneal doses of L-arginine (250 mg / 100 g) in a rat model.

RESULTS

Pinocembrin ameliorated the histological and immunohistochemical changes in pancreatic tissues and lowered the activities of pancreatic amylase and lipase that were markedly elevated with L-arginine administration. Moreover, pinocembrin reinstated the oxidant/antioxidant equilibrium, which was perturbed by L-arginine, and boosted the pancreatic levels of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1). Pinocembrin markedly reduced the elevation in serum C-reactive protein (CRP) level induced by L-arginine. Additionally, it decreased the expression of high motility group box protein 1 (HMGB1), toll-like receptor 4 (TLR4), nuclear factor kappa B (NF-κB), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and NOD-like receptor (NLR) Family Pyrin Domain Containing 3 (NLRP3) inflammasome in the pancreas. Furthermore, it also reduced myeloperoxidase (MPO) activity. Pinocembrin markedly downregulated miR-34a-5p expression and upregulated the protein levels of peroxisome proliferator-activated receptor alpha (PPAR-α) and Sirtuin 1 (SIRT1) and the gene expression level of the inhibitor protein of NF-κB (IκB-α), along with normalizing the Bax/Bcl-2 ratio.

CONCLUSIONS

Pinocembrin notably improved L-arginine-induced APS by its antioxidant, anti-inflammatory, and anti-apoptotic activities. Pinocembrin exhibited a protective role in APS by suppressing inflammatory signaling via the TLR4/NF-κB/NLRP3 pathway and enhancing cytoprotective signaling via the miR-34a-5p/SIRT1/Nrf2/HO-1 pathway.

Unexpected location of a pilonidal sinus

Pilonidal sinus disease is typically located in the sacrococcygeal area, although it has been described in other locations. We present a rare case of pilonidal sinus on the scalp and its management.

Exercise affects high-fat diet-stimulated breast cancer metastasis through irisin secretion by altering cancer stem cell properties

Background

Regular physical activities reduce the growth of breast cancer, but research on the effects of steady exercise on metastasis and its mechanisms is limited. In this study, the effects of steady exercise on breast cancer metastasis and its possible mechanism were demonstrated.

Methods

Experimental metastasis was induced after 8 weeks of steady exercise using a mouse model. Furthermore, one of the myokines, irisin, was studied to elucidate the effects of metastasis-regulating protein expression, and colony and sphere formation, which are cancer stem cell properties.

Results

Low- and moderate-intensity exercise significantly reduced the number and volume of metastasized tumors. Among myokines, only irisin was significantly increased by steady exercise but decreased by a high-fat diet. In vitro studies, irisin significantly decreased the number of colonies and sphere formation. Irisin also inhibited cell migration and invasion and suppressed the malignancy of breast cancer cells by reducing the expression of vimentin, MMP-2, MMP-9, and HIF-1 and by increasing the expression of TIMP-1 and TIMP-2.

Conclusion

Steady exercise modulates myokine secretions and among them, irisin suppresses breast cancer metastasis by decreasing self-renewal properties and invasion regulating protein expressions. Thus, regular exercise may be beneficial in the prevention of breast tumor metastasis.

Experimental models of high-risk bowel anastomosis in rats: A systematic review

BACKGROUND

Anastomotic leaks remain one of the most dreaded complications in gastrointestinal surgery causing significant morbidity, that negatively affect the patients' quality of life. Experimental studies play an important role in understanding the pathophysiological background of anastomotic healing and there are still many fields that require further investigation. Knowledge drawn from these studies can lead to interventions or techniques that can reduce the risk of anastomotic leak in patients with high-risk features. Despite the advances in experimental protocols and techniques, designing a high-quality study is still challenging for the investigators as there is a plethora of different models used.

AIM

To review current state of the art for experimental protocols in high-risk anastomosis in rats.

METHODS

This systematic review was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To identify eligible studies, a comprehensive literature search was performed in the electronic databases PubMed (MEDLINE) and Scopus, covering the period from conception until 18 October 2023.

RESULTS

From our search strategy 102 studies were included and were categorized based on the mechanism used to create a high-risk anastomosis. Methods of assessing anastomotic healing were extracted and were individually appraised.

CONCLUSION

Anastomotic healing studies have evolved over the last decades, but the findings are yet to be translated into human studies. There is a need for high-quality, well-designed studies that will help to the better understanding of the pathophysiology of anastomotic healing and the effects of various interventions.

Are Meteorin-Like Peptide and Asprosin Important in the Diagnosis of Breast Tumors?

INTRODUCTION

Breast cancer (BC) is one of the most common and leading causes of death in women. Therefore, early and accurate diagnosis is vital. In this study, meteorin-like (METRNL) peptide and asprosin levels were examined in breast tissue in invasive ductal carcinoma (IDC) of the breast, and the roles of these molecules in the diagnosis of BC were investigated.

METHODS

In this retrospective study, tissues from patients with BC in the Pathology Department Laboratory of Fırat University Faculty of Medicine, Elazığ, Turkey, were used. Samples from 30 patients were used. The control group consisted of healthy breast tissues from the same patients. The pathology group consisted of breast tissues with IDC from the same patients. Breast tissue samples from both groups were evaluated immunohistochemically for METRNL and asprosin.

RESULTS

Statistically significant differences were observed between both groups in terms of METRNL and asprosin. It was observed that METRNL and asprosin immunoreactivities were higher in breast tissues with IDC than in healthy breast tissues (p<0.001).

CONCLUSION

When the study results were evaluated, it was seen that there was a significant relationship between healthy breast tissues and the ones with IDC in terms of METRNL and asprosin. It is thought that both METRNL and asprosin may be really important in the future for the early diagnosis and treatment of BC.

Surgeons' Experience and Practices in Managing the Pilonidal Sinus in the Kurdistan Region of Iraq

Background Despite pilonidal sinus disease being a prevalent issue, there are still many challenges and controversies regarding its management. This study aimed to evaluate the experiences and practices of surgeons in the Kurdistan region of Iraq in the management of the pilonidal sinus and determine the most preferred treatment method, recurrence rates, and other complications related to different treatment methods. Methods This cross-sectional study was conducted on a convenience sample of 104 surgeons in the Kurdistan region of Iraq from January to February 2024 using an online survey based on Google Forms. A questionnaire was developed for data collection that included data on the experience and practice of pilonidal sinus treatment. Results The most common procedure followed by the study participants to manage the pilonidal sinus included primary open (n = 61/104, 58.7%), followed by primary closure (n = 20/104, 19.2%). The most common reasons or advantages for performing specific procedures to manage the pilonidal sinus were a lower recurrence rate (n = 73/104, 70.2%), safer procedures (n = 60/104, 57.7%), shorter operation times (n = 57/104, 54.8%), and shorter hospital stays (n = 53/104, 51.0%). The primary open method was the most commonly used method (n = 46/104, 44.3%), followed by simple incision and drainage (n = 25/104, 24.0%), primary closure (n = 23/104, 22.1%), and off-midline closure (n = 10/104, 9.6%). Most of the participants agreed that the primary open had the lowest recurrence rate (n = 68/104, 65.4%), while simple incision and drainage (n = 50/104, 48.1%) and primary closure (n = 29/104, 27.9%) were associated with frequent recurrence. Conclusions Standard treatment of pilonidal sinus disease is still not available. Most surgeons in the Kurdistan region of Iraq prefer the open method, which is the easiest, safest, and least recurrent yield method. However, it is the most painful and has the longest recovery time.

Sitagliptin ameliorates L-arginine-induced acute pancreatitis via modulating inflammatory cytokines expression and combating oxidative stress

Background

Acute pancreatitis (AP) is an inflammatory condition that resolves spontaneously, but occasionally, develops into systemic inflammation, organ failure and mortality. Oxidative stress and activation of inflammatory pathways represent major players in AP pathogenesis. Current management of AP relies on attenuating injuries to the pancreas and putting the inflammatory process under control. In this study, we investigated the role of sitagliptin in modulating L-arginine-induced AP in rats.

Methods

Swiss rats were subdivided into a healthy control group, AP group (a single dose of L-arginine 250 mg/100 g, intraperitoneal), and sitagliptin + L-arginine-treated group (10 mg sitagliptin/kg body weight/day, orally). Sitagliptin treatment started 1 hour after L-arginine injection and continued for 3days. Biochemical and histopathological investigations were performed on serum and tissue samples collected from test animals.

Results

L-arginine increased pancreatic meyloperoxidase and serum amylase- and lipase activities and serum levels of TNF-α, LT-α, IFN-γ, IL-1α/β, IL-6, IL-10, IL-12, and IL-15. AP animals showed elevated MDA and NO and decreased GSH and serum calcium levels. Histopathological changes were observed by H&E staining. Sitagliptin treatment significantly ameliorated these biochemical and histological changes diminishing the signs of AP.

Conclusion

Sitagliptin treatment was effective in ameliorating L-arginine-induced AP which can be regarded to its anti-inflammatory and antioxidant effect.

Effects of naringenin on oxidative damage and apoptosis in liver and kidney in rats subjected to chronic mercury chloride

Mercury chloride is a type of heavy metal that causes the formation of free radicals, causing hepatotoxicity, nephrotoxicity and apoptosis. In this study, the effects of naringenin on oxidative stress and apoptosis in the liver and kidney of rats exposed to mercury chloride were investigated. In the study, 41 2-month-old male Wistar-Albino rats were divided into five groups. Accordingly, group 1 was set as control group, group 2 as naringenin-100, group 3 as mercury chloride, group 4 as mercury chloride + naringenin-50, and group 5 as mercury chloride + naringenin-100. For the interventions, 1 mL/kg saline was administered to the control, 0.4 mg/kg/day mercury (II) chloride to the mercury chloride groups by i.p., and 50 and 100 mg/kg/day naringenin prepared in corn oil to the naringenin groups by gavage. All the interventions lasted for 20 days. Mercury chloride administration was initiated 1 h following the administration of naringenin. When mercury chloride and the control group were compared, a significant increase in plasma urea, liver and kidney malondialdehyde (MDA) levels, in kidney superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione-S-transferase (GST) activities (p < .001), and a significant decrease in liver and kidney glutathione (GSH) levels (p < .001), in liver catalase (CAT) activity (p < .01) were observed. In addition, histopathological changes and a significant increase in caspase-3 levels were detected (p < .05). When mercury chloride and treatment groups were compared, the administration of naringenin caused a decrease aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH) (p < .01), urea, creatinine levels (p < .001) in plasma, MDA levels in liver and kidney, SOD, GSH-Px, GST activities in kidney (p < .001), and increased GSH levels in liver and kidney. The addition of naringenin-100 increased GSH levels above the control (p < .001). The administration of naringenin was also decreased histopathological changes and caspase-3 levels (p < .05). Accordingly, it was determined that naringenin is protective and therapeutic against mercury chloride-induced oxidative damage and apoptosis in the liver and kidney, and 100 mg/kg naringenin is more effective in preventing histopathological changes and apoptosis.

The Impact of Platelet-Rich Plasma Application during Cesarean Section on Wound Healing and Postoperative Pain: A Single-Blind Placebo-Controlled Intervention Study

Background/Objectives: The aim of this study was to evaluate if platelet-rich plasma (PRP) application into the wound during cesarean delivery improves wound healing and reduces pain in the postoperative period. Materials and Methods: A total of 46 patients undergoing cesarean section (CS) were included in this single-blind placebo-controlled intervention study: 23 women in the PRP group and 23 in the placebo group. Every patient was asked to evaluate pain by using the Visual Analogue Scale (VAS) immediately after surgery, as well as 6 and 12 h after the surgery. The use of analgetics was also recorded. The postoperative scar was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Results: There was no case of wound dehiscence in either group. Significant differences between the groups in the scar quality assessment were detected in both patient and doctor POSAS results on days 8, 30 and 90 after surgery in the favor of the PRP group. There was no difference in the pain intensity assessment on the VAS recorded after surgery, but PRP patients required fewer paracetamol doses per day than the control group. Conclusions: PRP application during CS significantly improved wound healing in both short- and long-term assessment. Although it did not influence postoperative pain intensity, it may reduce the use of analgetics after surgery.

Pilonidal disease in the pregnant patient: A case report

INTRODUCTION

Pilonidal disease in the pregnant patient is underreported and may be instigated by significant shifts in hormone levels throughout pregnancy and the postpartum period.

PRESENTATION OF CASE

An otherwise healthy primigravid 22-year-old woman developed pilonidal disease at the beginning of her pregnancy. While pregnant, her symptoms recurred once and resolved without treatment. She was managed non-operatively during pregnancy. Her symptoms recurred again in the postpartum period but they quickly resolved. Due to the recurrent symptoms, she underwent definitive management via minimally invasive Gips procedure in the postpartum period, without further recurrence.

DISCUSSION

Pilonidal disease affects pregnant patients and can be managed non-operatively. The etiology of pilonidal disease in the setting of pregnancy may be related to hormonal shifts and warrants further investigation.

CONCLUSION

We present the first report of pilonidal disease in a pregnant patient in the primary literature. The hormonal shifts associated with pregnancy may be associated with the development of pilonidal disease in the pregnant patient.

Evaluate the Serum of Irisin, Omentin-1, and Oxidative Status in Males with Prostatic Cancer

Background

Prostate cancer is a classic public health problem in males and has broadly different levels of mortality and morbidity. As an endocrine gland, adipose tissue synthesizes and secretes a variety of bioactive peptides, such as irisin and omentin-1. Adipokines and oxidative stress potentially contribute to the proliferation of prostatic carcinoma cells. The relationship between irisin, omentin-1, and oxidative stress has not been widely investigated in prostate cancer. Therefore, the present research assessed whether there is a significant correlation between irisin and omentin-1 levels and oxidative status in prostate cancer individuals.

Methods

The present research recruited 40 individuals diagnosed with prostate cancer and 40 healthy individuals for comparative purposes. All individuals underwent demographics, biochemicals, and serum adipokines (irisin and omentin-1) data analysis.

Results

The means of total prostate-specific antigen (43.3±20.5 vs. 2.5±1.2) and free prostate-specific antigen (2.1±1.4 vs. 0.08±0.02) were highly significant increases in the prostate cancer patients than in the healthy individuals. Furthermore, the means of omentin-1 (31.6±12.8 vs. 23.5±14.1) and total oxidant stress (22.4±10.6 vs. 9.1±3.6) were highly significant increases in patients with prostate cancer than in healthy individuals. In contrast, the means of irisin (343.5±240.2 vs. 716.4±142.3) and total antioxidant capacity (2.2±1.2 vs. 3.3±1.3) were highly significant decreases in patients with prostate cancer than in healthy individuals. No significant relationship was demonstrated between all parameters in the two groups under study.

Conclusions

The study findings indicate that irisin and omentin-1 could serve as biomarkers for predicting prostate cancer.

The Role of the Myokine Irisin in the Protection and Carcinogenesis of the Gastrointestinal Tract

Recently discovered irisin, a member of the myokines family, is a potential mediator of exercise-induced energy metabolism and a factor promoting browning of the white adipose tissue. Recent evidence indicates that this myokine, released from contracting muscles, can mediate the beneficial effects of exercise on health. Irisin may be a potential therapeutic agent against obesity and has been shown to play an important role in the protection of various cells, tissues, and organs due to its anti-inflammatory, antioxidative, and anti-cancer properties. Our aim was to review the recent experimental and clinical studies on irisin and its expression, release into the bloodstream, tissue targets, and potential contribution to the protective effects of exercise in the gastrointestinal tract. Particular emphasis was placed on inflammatory bowel disease, intestinal ischemia/reperfusion injury, periodontitis, and other digestive tract disorders, including carcinogenesis. Overall, irisin holds significant potential as a novel target molecule, offering a safe and therapeutic approach to treating various gastrointestinal diseases.

Oxidative Stress in Postbariatric Patients: A Systematic Literature Review Exploring the Long-term Effects of Bariatric Surgery

Background

The present study investigates the impact of oxidative stress after bariatric surgery in patients with obesity. This field of study has gained great interest in recent years due to the role that oxidative stress plays in metabolic diseases. Obesity, by itself, can generate an increase in reactive oxygen and nitrogen species, intensifying cellular damage and promoting the progression of adverse metabolic conditions. In this context, bariatric surgery emerges as a candidate capable of modifying oxidative stress biomarkers, facilitating the patient's metabolic recovery.

Methods

A systematic review was carried out, identifying 30 studies found in databases such as PubMed, Scopus, Web of Science, and Google Scholar. It looked at the link between oxidative stress and recovery after bariatric surgery in patients. The selection of studies was based on the measurement of oxidative stress biomarkers before and after surgical intervention.

Results

The results reveal a significant decrease in oxidative stress biomarkers after bariatric surgery. However, a notable variability in antioxidant activity is observed between different patients, as well as a significant influence of comorbidities.

Conclusions

Bariatric surgery is postulated as an effective intervention in reducing oxidative stress in patients with obesity, enhancing antioxidant activity and improving patient recovery. This finding highlights the importance of considering oxidative stress management as an integral part of postoperative care, suggesting the need to implement complementary treatment strategies to optimize health outcomes.

Postoperative results of modified Karydakis flap method for primary sacrococcygeal pilonidal sinus disease: short and long-term analysis

BACKGROUND

Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long-term outcomes of the modified Karydakis flap method in patients with sacrococcygeal pilonidal sinus.

METHODS

A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon between September 2015 and February 2021. The patients' demographics, operative time, hospitalization time and complications were recorded.

RESULTS

Of the 175 patients, 125 (71.43%) were male and 50 (28.57%) were female, with a mean age of 24.93 ± 10.27 years. The mean operative time was 55.05 ± 12.33 min, the follow-up time was 39.21 ± 17.58 months, and the mean hospitalization time was 3.4 ± 1.65 days. Complications were observed in 12 (6.85%) patients, including seroma (5.14%) and wound infection (1.71%), with no observed cases of flap necrosis or recurrence.

CONCLUSION

The modified Karydakis flap method appears to be a safe and effective treatment option for sacrococcygeal pilonidal sinus, with an acceptable complication rate and no observed cases of recurrence.

Role of asprosin and meteorin-like peptide in progression of actinic keratosis to squamous cell carcinoma

Squamous cell carcinoma (SCC) often develops from an underlying premalignant lesion. Factors that affect the progression of actinic keratosis (AK) to invasive SCC are not fully known. Asprosin (ASP) and meteorin-like peptide (METRNL) are adipokines that are involved primarily in glucose metabolism. We investigated the expression of ASP and METRNL in AK and SCC to evaluate the role of these adipokines in the development of SCC. We used 15 SCC specimens, 12 AK specimens and 12 healthy control skin specimens. ASP and METRNL protein expression in tumor and surrounding tissue was evaluated using immunohistochemistry. ASP expression in tumor tissue was significantly greater in the SCC group than in the control and AK groups, but it did not differ significantly between the AK and control groups. A positive correlation was observed for both ASP and METRNL expressions between tumor tissue and adjacent epidermis, hair follicles, sebaceous gland, eccrine gland, inflammatory cells and vascular structures. ASP and METRNL may exert pro-tumor effects toward development of invasive SCC. The expression intensity of ASP and METRNL can be used as a biomarker of risk of progression to SCC.

Chronic Appendicitis: Possible Differential Diagnosis in Patients with Chronic Abdominal Pain

In the emergency department, patients frequently present with abdominal pain, with a variety of different causes ranging from intra-abdominal to extra-abdominal and retroperitoneal pathologies which can affect all age groups. Chronic appendicitis is a rare medical condition characterized by less severe and continuous abdominal pain and a clinical picture lasting longer than 1-2 days and extending over months, even years, and it is not always possible to consider it as a preliminary diagnosis. We represent a case report of chronic appendicitis where the patient's clinical picture led the diagnostics and treatment in different directions and delayed the diagnosis. Namely, our patient was radiologically diagnosed with a collection of denser content retroperitoneally in the right lower quadrant of the abdomen, which in the first place was not related to possible appendicitis, regarding complaints. The existence of chronic appendicitis is a diagnosis unfamiliar to many clinicians and has no official diagnostic criteria. After diagnosis, treatment usually begins with antibiotics, and the next most common step is surgery. The optimal treatment for this condition is unknown. With this case report, we wish to draw attention to chronic appendicitis as a possible differential diagnosis in patients with chronic abdominal pain.

Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults: A Randomized Clinical Trial

Importance

Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease.

Objective

To compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults.

Design, Setting, and Participants

This was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital.

Intervention

LE and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone.

Main Outcomes and Measures

The primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications.

Results

A total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications.

Conclusions and Relevance

LE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients.

Trial Registration

ClinicalTrials.gov Identifier: NCT03276065.

Mastalgia - The Burden Beneath

Objective

Mastalgia is the most common breast-related complaint. A multitude of hormonal changes and lifestyle associated factors have been implicated in its causation. A long list of treatment modalities have been tried with varying success rates. To identify the most common risk factors and the most effective management strategies for mastalgia in our clinic population.

Materials and Methods

A total of 100 women between 18-65 years of age presenting to the breast clinic with mastalgia were followed throughout their course of diagnosis and management. Stepwise treatment was provided, starting with reassurance and breast support and progressing to include pharmacological measures, when necessary. The risk factors and outcomes of treatment were analysed.

Results

The majority (66%) were aged 25-47 years and the left breast was found to be most frequently involved. Involvement of the upper outer quadrant was significantly more common. Lump/nodularity was the most prevalent risk factor. Most patients showed a positive response to non-steroid anti-inflammatories (NSAIDs) in addition to reassurance, breast support and dietary changes.

Conclusion

A detailed history and clinical examination helps to identify the risk factors and the best approach for the management of mastalgia. Educating women regarding breast self-examination at regular intervals helps in early presentation and diagnosis of the underlying condition. Reassurance, breast support and lifestyle changes are the first line treatment and have good results in a significant number of patients. In our practice topical and oral NSAIDs, evening primrose oil and vitamin E were frequently used as additional treatments to non-pharmacological methods.

Identification of Risk Factors for Mastalgia and Its Relationship with Benign or Malignant Breast Diseases

Objectives

Mastalgia is a medical condition that primarily affects women of all age groups. Affected individuals experience excruciating pain, tightness, or a burning sensation in the breast tissue. The aim of this study is to observe the clinicopathologic features of women with mastalgia and compare these features with asymptomatic cases.

Methods

A total of 524 female patients who applied to the general surgery outpatient clinic were prospectively evaluated. The patients were divided into two groups. Group 1 (G1) included patients with mastalgia, while Group 2 (G2) included asymptomatic patients. The two groups were compared in terms of clinical, radiological, and pathological features.

Results

This study was conducted on 524 women, among whom the prevalence of mastalgia was found to be 61.45%. There were 322 patients in G1 and 202 patients in G2. The mean age was significantly higher in G2 compared to G1 (46.33±10.33 vs. 43.58±10.33, respectively; p=0.001). Premenopausal women rates for G1 and G2 were 73.91% and 59.4%, respectively (p=0.001). The regular exercise rate in G1 was 18.01%, while it was 25.74% in G2 (p=0.034). The past history of breast cancer rate was significantly higher in G2 than in G1 (p=0.015). The consumption of analgesics was significantly lower in G2 compared to G1 (p=0.05). Non-steroidal anti-inflammatory drugs were the most commonly used analgesic drug class in both groups, with significant intergroup differences (G1: 27.63%, G2: 19.8%, p=0.043). Screening mammography with or without ultrasound examination was performed significantly more often in G2 compared to G1 (66.33% vs. 55.27% and 82.17% vs. 72.98%, p=0.012 and p=0.016, respectively). No significant difference was found concerning the frequency of benign or malignant pathologies between the groups.

Conclusion

Breast pain is common and should be considered physiological without other breast symptoms and after excluding non-breast causes. It is safe to provide symptom control advice and reassurance to patients who have breast pain but do not have signs or symptoms indicating a possible serious underlying condition requiring further medical intervention.

Platelet-rich plasma for pilonidal disease: a systematic review

OBJECTIVE

To examine the use of platelet-rich plasma (PRP) for treatment of pilonidal disease (PD) and thus provide a reference for clinical application.

METHODS

A systematic review of PubMed and the Cochrane Library was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We considered all studies that reported the use of PRP for treatment of PD. Extracted data included the first author's name, year of publication, study type, number of included patients, inclusion and exclusion criteria, interventions, anesthesia, application of PRP (source, preparation, dose, and operation), antibiotics, follow-up time, therapeutic outcomes, and adverse events.

RESULTS

In total, eight randomized controlled trials and one prospective cohort study involving 809 patients were included. PRP reduced pain, accelerated healing, and reduced adverse events. The application of combined minimally invasive surgery achieved better results. However, overfilling of the wound with PRP in minimally invasive surgeries was shown to potentially increase the risk of adverse events.

CONCLUSION

PRP can be used as an adjuvant treatment in PD surgery to improve the therapeutic effect and reduce adverse events. The optimal combination of PRP and various factors is an important direction of future research.INPLASY registration number: INPLASY2023100070.

Assessment of prevalence and factors affecting Mastalgia among early reproductive-aged women in Bangladesh: a cross-sectional survey

BACKGROUND

Mastalgia, or breast pain, is a prevalent and distressing condition experienced by women, impacting their daily lives and causing complications. It is common among women of reproductive age, with associations found with premenstrual syndrome, fibrocystic breast disease, psychological distress, and, in rare cases, breast cancer. While Western societies have high frequencies of Mastalgia, it is less diagnosed in Asian cultures including Bangladesh. This study aimed to investigate the prevalence and factors associated with Mastalgia among early reproductive-aged women in Bangladesh.

METHODS

A cross-sectional survey was conducted, and data were collected from different regions of the country. A convenience sampling method was used to take 1,214 participants for the study. A pre-tested semi-structured questionnaire was used to collect data. Bivariate and multivariate analyses were conducted to ascertain factors that were significantly associated with Mastalgia. The data were analyzed using the SPSS software 26 version.

RESULTS

All the participants were female (mean age: 22.87 ± 2.64 years; age ranges: 18-35 years). The prevalence of Mastalgia was found to be 35.5%. The study was conducted using a self-reported semi-structured questionnaire. Participants with a higher education level and higher income were more likely to experience Mastalgia. A family history of breast cancer and severe abdominal pain during menstruation were also identified as associated factors for Mastalgia (p < 0.05).

CONCLUSIONS

This study enhances our understanding of Mastalgia in Bangladesh, offering insights for healthcare and policy. Further research is required to uncover its root causes and develop effective interventions. The study highlights the prevalence of mastalgia and its related factors, emphasizing the necessity for increased awareness and support for affected women.

Use of the laser in the pilonidal sinus alone or in combination with phenol

OBJECTIVE

We investigated the effectiveness of combining laser treatment with phenol in the management of pilonidal sinus.

METHODS

We present here a retrospective analysis of patients with pilonidal sinus disease who were treated in the general surgery clinic of the Balikesir University Hospital between October 2019 and February 2022.

RESULTS

Recurrence was observed in three patients (13.6%) in the laser treatment group and one patient (4.8%) in the laser-phenol treatment group after the fourth month. Notably, 22 (91.7%) patients in the laser treatment group and 21 (95.5%) patients in the laser-phenol treatment group had complete healing.

CONCLUSION

Although not statistically significant, the laser-phenol treatment group exhibited a lower recurrence rate and a higher complete healing rate.

Potential role of irisin in digestive system diseases

Digestive system diseases (DSD) are very complex conditions that severely threaten human health. Therefore, there is an urgent need to develop new pharmacological treatment strategies. Irisin, a myokine discovered in 2012, is produced by fibronectin type III domain-containing protein 5 (FNDC5), which is a transmembrane protein. Irisin is involved in promoting the browning of white adipose tissue, the regulation of energy metabolism, and the improvement of insulin resistance. Irisin is also an essential mediator of the inflammatory response, oxidative stress, and cell apoptosis. Recent studies have proved that irisin concentration is altered in DSD and exerts pivotal effects on the initiation, progression, and prognosis of these diseases through various mechanisms. Therefore, studying the expression and function of irisin may have great significance for the diagnosis and treatment of DSD. Here, we focus on irisin and explore the multiple molecular pathways targeted by irisin therapy. This review indicates that irisin can serve as a diagnostic marker or potential therapeutic agent for DSD. DATA AVAILABILITY: Not applicable.

Sodium pyruvate improves the plasma amino acid profile in rats with L-arginine-induced acute pancreatitis

Plasma amino acid levels are altered upon many pathological conditions including acute pancreatitis. It is unclear whether amino acids can be used as specific biomarker of acute pancreatitis severity or recovery. Development of acute pancreatitis is associated with mitochondrial dysfunction and decreased cytosolic ATP level. Sodium pyruvate is considered as a potential treatment of pancreatitis due to its ability to sustain mitochondrial oxidative and ATP-productive capacity in vitro. This study investigated the effect of sodium pyruvate on pancreatic morphology and plasma amino acid levels in rats with acute pancreatitis. Acute pancreatitis in rats was induced by administration of L-arginine (5 g/kg) Experimental treatment group received sodium pyruvate (1 g/kg) for 4 days. On day 8 of the experiment, animals were killed, blood was collected and plasma amino acid concentration was determined with high-performance liquid chromatography. Histological examination showed large areas of fibrosis in the pancreas of animals treated with L-arginine irrespectively of sodium pyruvate administration. Sodium pyruvate improved the plasma amino acid levels. Rats with acute pancreatitis had significantly lower levels of most essential and non-essential amino acids and increased glutamate and aspartate in plasma. Administration of sodium pyruvate completely or partially restored the levels of methionine, phenylalanine, tryptophan, leucine, isoleucine, aspartate, asparagine and ornithine levels, while increasing glutamine and serine to levels significantly higher than control. Plasma lysine, alanine, arginine and taurine remained unaffected in all experimental groups. Sodium pyruvate may be considered for use as a maintenance therapy in acute pancreatitis.

Psychological Assessment and Treatment Effectiveness in Mastalgia: Developing a Treatment Algorithm

Background Mastalgia often impairs the physical, social, and sexual lives of women. It may manifest in both cyclical or acyclical patterns. The psychoneurotic association of mastalgia has been claimed for a long time in various available literature. Several treatment options have been used and are available in the market for mastalgia, but no specific guidelines are currently in place at the global or local levels. This study aims to evaluate the psychological status and effectiveness of various treatment options in women presenting with mastalgia. Methods This study was conducted in the General Surgery outpatient department from February 1 to November 30, 2021, at King George's Medical University, Lucknow, India. Females of all age groups presenting to the General Surgery outpatient department with unilateral/bilateral breast pain and/or chest wall pain were considered for this study. Pregnant patients, those with a history of allergy to drugs, or those who were lost to follow-up were excluded from the study. The psychological status of patients was assessed using the Depression Anxiety and Stress Scale (DASS-42) scale. Pain assessment was performed using a visual analog scale (VAS). Patients were divided into five categories: (i) isolated chest wall pain, (ii) isolated breast pain, (iii) both chest wall and breast pain, (iv) pain with an associated lump(s), and (v) pain and tenderness isolated over the lump, and two groups: Group-A: VAS≤4, and Group-B: VAS>4. Group B patients in Category iv were randomized into two groups: topical non-steroidal anti-inflammatory drugs (NSAIDs) or evening primrose oil+vitamin E. The next line of treatment was tamoxifen 10mg followed by danazol 100mg followed by ormeloxifene 30mg. Results The mean age of 106 participants enrolled was 31.59±10.52 years. The mean scores, using the DASS-42 scale, for depression, anxiety, and stress were 7.31±8.53, 7.08±6.57, and 11.15±8.07, respectively. The depression, anxiety, and stress scores had no significant correlation with pain scores (p =0.84, 0.99, and 0.97 for depression, anxiety, and stress, respectively), or duration (p=0.69, 0.66, and 0.85 for depression, anxiety, and stress, respectively). Twenty-nine of 43 patients (67.44%) responded to topical NSAIDs as first-line treatment, and out of the remaining, 6.98% responded to evening primrose oil + vitamin E, 18.60% to tamoxifen, and 4.65% to danazol. Twenty-nine of 32 patients (90.63%) responded to evening primrose oil+vitamin E as first-line treatment, while 6.25% and 3.12% responded to tamoxifen and danazol, respectively.  Conclusions Both topical NSAIDs and evening primrose oil + vitamin E were found effective first-line treatment options in the majority of patients. Hence, it is always advisable to start such patients on topical NSAIDs, or evening primrose oil + vitamin E, before switching over (if no resolution of pain is reported with these drugs) to higher and more severe treatment options. The duration or severity of pain did not correlate with the psychological condition of the patient.

Antioxidant Capacity of Melatonin against Oxidative Stress Caused by Exercise-Induced Weight Loss in Rats

Antioxidant supplements such as melatonin are used to prevent oxidative stress during exercise. This study aimed to investigate the antioxidant capacity of melatonin supplementation against oxidative stress induced by the weight loss observed during exercise. Forty Wistar Albino male rats were subjected to 10 days of jogging exercises. Two groups were formed based on weight loss. Two subgroups were created in each group. Melatonin (5 mg/kg) was administered to each subgroup in each group. The other subgroups were designated as control subgroups. Blood samples were collected after 10 d. Superoxide dismutase (SOD), total antioxidant status (TAS), glutathione peroxidase, melatonin, and malondialdehyde levels were analyzed in blood samples. SOD, glutathione peroxidase, TAS, and melatonin levels in the melatonin subgroup were higher than those in the control subgroup in the non-weight loss group. In contrast, the malondialdehyde levels were lower. Melatonin levels in the melatonin subgroup were higher than those in the control subgroup in the weight loss group. Conversely, the SOD and TAS levels were lower. In addition, there was a positive correlation between weight loss and malondialdehyde levels and a negative correlation with SOD, TAS, and melatonin levels. Melatonin (5 mg/kg) supplementation showed antioxidant capacity in exercise without weight loss, but was insufficient in exercise with weight loss.