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Keller DS, Curtis N, Burt HA, Ammirati CA, Collings AT, Polk HC, Carrano FM, Antoniou SA, Hanna N, Piotet LM, Hill S, Cuijpers ACM, Tejedor P, Milone M, Andriopoulou E, Kontovounisios C, Leeds IL, Awad ZT, Barber MW, Al-Mansour M, Nassif G, West MA, Pryor AD, Carli F, Demartines N, Bouvy ND, Passera R, Arezzo A, Francis N. EAES/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults. Surg Endosc 2024; 38:4104-4126. [PMID: 38942944 PMCID: PMC11289045 DOI: 10.1007/s00464-024-10977-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND As the population ages, more older adults are presenting for surgery. Age-related declines in physiological reserve and functional capacity can result in frailty and poor outcomes after surgery. Hence, optimizing perioperative care in older patients is imperative. Enhanced Recovery After Surgery (ERAS) pathways and Minimally Invasive Surgery (MIS) may influence surgical outcomes, but current use and impact on older adults patients is unknown. The aim of this study was to provide evidence-based recommendations on perioperative care of older adults undergoing major abdominal surgery. METHODS Expert consensus determined working definitions for key terms and metrics related to perioperative care. A systematic literature review and meta-analysis was performed using the PubMed, Embase, Cochrane Library, and Clinicaltrials.gov databases for 24 pre-defined key questions in the topic areas of prehabilitation, MIS, and ERAS in major abdominal surgery (colorectal, upper gastrointestinal (UGI), Hernia, and hepatopancreatic biliary (HPB)) to generate evidence-based recommendations following the GRADE methodology. RESULT Older adults were defined as 65 years and older. Over 20,000 articles were initially retrieved from search parameters. Evidence synthesis was performed across the three topic areas from 172 studies, with meta-analyses conducted for MIS and ERAS topics. The use of MIS and ERAS was recommended for older adult patients particularly when undergoing colorectal surgery. Expert opinion recommended prehabilitation, cessation of smoking and alcohol, and correction of anemia in all colorectal, UGI, Hernia, and HPB procedures in older adults. All recommendations were conditional, with low to very low certainty of evidence, with the exception of ERAS program in colorectal surgery. CONCLUSIONS MIS and ERAS are recommended in older adults undergoing major abdominal surgery, with evidence supporting use in colorectal surgery. Though expert opinion supported prehabilitation, there is insufficient evidence supporting use. This work has identified evidence gaps for further studies to optimize older adults undergoing major abdominal surgery.
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Affiliation(s)
- Deborah S Keller
- Department of Digestive Surgery, University of Strasbourg, Strasbourg, FR, USA
| | - Nathan Curtis
- Surgical Unit, Dorset County Hospital, Dorchester, Dorset, UK
| | | | | | - Amelia T Collings
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hiram C Polk
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Francesco Maria Carrano
- Department of General and Minimally Invasive Surgery, Busto Arsizio Circolo Hospital, ASST-Valle Olona, Varese, Italy
| | - Stavros A Antoniou
- Department of General Surgery, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Nader Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - Sarah Hill
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Anne C M Cuijpers
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Patricia Tejedor
- Department of Colorectal Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | - Marco Milone
- Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples "Federico II", Via Pansini 5, Naples, Italy
| | - Eleni Andriopoulou
- Department of Surgery, Hellenic Red Cross Korgialeneio Benakeio NHS, Athens, Greece
| | - Christos Kontovounisios
- Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Campus and the Royal Marsden Hospital, London, UK
| | - Ira L Leeds
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Meghan Wandtke Barber
- Department of Surgery, The University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Mazen Al-Mansour
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - George Nassif
- Department of Colorectal Surgery, AdventHealth, Orlando, FL, USA
| | - Malcolm A West
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton, Southampton, UK
- Complex Cancer and Exenterative Service, University Hospitals Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University of Southampton, Southampton, UK
| | - Aurora D Pryor
- Long Island Jewish Medical Center and System Chief for Bariatric Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Great Neck, NY, USA
| | - Franco Carli
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | | | - Nicole D Bouvy
- Innovative Surgical Techniques, Endoscopic and Endocrine Surgery, Department of Surgery, Maastricht University Medical Center, Amsterdam, Netherlands
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Turin, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Nader Francis
- Department of Surgery, Yeovil District Hospital, Higher Kingston, Yeovil, UK.
- The Griffin Institute, Northwick Park and St Mark's Hospital, Y Block, Watford Rd, Harrow, HA1 3UJ, UK.
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Assi C, Boulos K, Haykal E, Caton J, Prudhon JL, Yammine K. Intraoperative live measurement of femoral head size for acetabular cup sizing: simple, accurate, and green! INTERNATIONAL ORTHOPAEDICS 2024; 48:2025-2031. [PMID: 38748096 DOI: 10.1007/s00264-024-06211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/02/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE Templating is the first step in achieving a successful total hip arthroplasty. We hypothesize that native head size is highly correlated with implanted cup size. Therefore, the purpose of this study is to look for a correlation between sizes of the intra-operative measurement of the femoral head and the implanted cup. METHODS This is a monocentric observational study conducted from December 2018 till January 2023. All patients admitted for a primary total hip arthroplasty were included and retrospectively reviewed. Intra-operative femoral head measurement, radiographic femoral head diameter, templated (planned) cup size, and definitive implanted cup size were recorded. RESULTS The sample included 154 patients (85 female and 69 males) with a mean age of 66.2 ± 10.4 years. There were 157 THA cases; 82 on the right side and 75 on the left side. The native head size and acetate template on digital radiographs were the most significantly positively correlated with cup size (P < 0.0001) while the radiological head size was significantly negatively correlated with cup size (P = 0.009). The implanted cup was on average 2 ± 2 mm bigger than the native head size measured intra-operatively. CONCLUSION The native femoral head diameter measured intra-operatively is a simple and reliable tool to help the surgeons choose the proper size of the acetabular cup, preventing complications during surgery hence optimizing results post operatively. This technique would contribute to a more ecofriendly orthopaedic reconstructive surgery.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Karl Boulos
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Emil Haykal
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon
| | | | | | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Beirut, Lebanon.
- Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon.
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Rizzo R, Vallicelli C, Ansaloni L, Coccolini F, Fugazzola P, Sartelli M, Agnoletti V, Baiocchi GL, Catena F. Usefulness of fluorescence imaging with indocyanine green for evaluation of bowel perfusion in the urgency setting: a systematic review and meta-analysis. Int J Surg 2024; 110:5071-5077. [PMID: 38768464 PMCID: PMC11325932 DOI: 10.1097/js9.0000000000001529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/14/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Fluorescence imaging with indocyanine green (ICG) has been extensively utilized to assess bowel perfusion in oncologic surgery. In the emergency setting, there are many situations in which bowel perfusion assessment is required. Large prospective studies or RCTs evaluating feasibility, safety and utility of ICG in the emergency setting are lacking. The primary aim is to assess the usefulness of ICG for evaluation of bowel perfusion in the emergency setting. MATERIALS AND METHODS The manuscript was drafted following the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). A systematic literature search was carried out through Pubmed, Scopus, and the ISI Web of Science. Assessment of included study using the methodological index for nonrandomized studies (MINORS) was calculated. The meta-analysis was carried out in line with recommendations from the Cochrane Collaboration and Meta-analysis of Observational Studies in Epidemiology guidelines, and the Mantel-Haenszel random effects model was used to calculate effect sizes. RESULTS 10 093 papers were identified. Eighty-four were reviewed in full-text, and 78 were excluded: 64 were case reports; 10 were reviews without original data; 2 were letters to the editor; and 2 contained unextractable data. Finally, six studies 22-27 were available for quality assessment and quantitative synthesis. The probability of reoperation using ICG fluorescence angiography resulted similar to the traditional assessment of bowel perfusion with a RD was -0.04 (95% CI: -0.147 to 0.060). The results were statistically significant P =0.029, although the heterogeneity was not negligible with a 59.9% of the I2 index. No small study effect or publication bias were found. CONCLUSIONS This first metanalysis on the use of IGC fluorescence for ischemic bowel disease showed that this methodology is a safe and feasible tool in the assessment of bowel perfusion in the emergency setting. This topic should be further investigated in high-quality studies.
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Affiliation(s)
- Roberta Rizzo
- Urgency and Emergency Surgery Department, Bufalini Hospital
| | | | - Luca Ansaloni
- Unit of General Surgery I, IRCCS San Matteo Hospital, University of Pavia, Pavia
| | | | - Paola Fugazzola
- Unit of General Surgery I, IRCCS San Matteo Hospital, University of Pavia, Pavia
| | | | - Vanni Agnoletti
- Anesthesia and Intensive Care Department, Bufalini Hospital, Cesena
| | | | - Fausto Catena
- Urgency and Emergency Surgery Department, Bufalini Hospital
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Fouad A, Berry A, Gates J, Kuti JL, Keating JJ. Effect of Blood Product Resuscitation on Cefazolin Pharmacokinetics in Trauma Patients. Surg Infect (Larchmt) 2024; 25:436-443. [PMID: 38995850 DOI: 10.1089/sur.2023.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024] Open
Abstract
Background: Antibiotics are frequently administered prophylactically to trauma patients with various injury patterns to prevent infectious complications. Trauma patients may also require large volume resuscitation with blood products. Limited data are available to support antibiotic dosing recommendations in this population. We hypothesized that we would be able to develop a population pharmacokinetic model of cefazolin, a frequently used antibiotic in the trauma scenario, from remnant blood samples by pharmacokinetic analysis of trauma patients. Methods: Remnant plasma from standard of care chemistry/hematology assessments was retrieved within 48 h of collection and assayed to determine cefazolin concentrations. Population pharmacokinetic analyses were conducted in Pmetrics using R. Linear regression was conducted to assess the effect of blood product resuscitation volume on cefazolin pharmacokinetic parameters. Results: Cefazolin concentrations best fitted a two-compartment model (Akaike information criterion: 443.9). The mean ± standard deviation parameters were total body clearance (4.3 ± 1.9L), volume of the central compartment (Vc: 7.7 ± 6.9L), and intercompartment transfer constants (k12: 1.3 ± 0.98 h-1, k21: 0.6 ± 0.45 h-1). No statistical relationships were observed between blood products, volume of blood products, and cefazolin clearance or Vc (R2: 0.0004-0.21, p = 0.08-0.95). Using a 5,000-patient Monte Carlo simulation, 2 g with repeated dosing every 2 h until end of surgery was required to achieve 93.2% probability of 100% free time above the minimum inhibitory concentration (MIC) (fT > MIC) at the ECOFF value for Staphylococcus aureus (2 mg/L). Conclusions: In these 15 trauma patients receiving blood transfusion, no relationship with blood volume resuscitation and cefazolin pharmacokinetics was observed. On the basis of this pharmacokinetic model, frequent cefazolin doses are required to maintain 100% fT > MIC.
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Affiliation(s)
- Aliaa Fouad
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | - Angela Berry
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | - Jonathan Gates
- Division of Acute Care Surgery, Hartford Hospital, Hartford, Connecticut, USA
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut, USA
| | - Jane J Keating
- Division of Acute Care Surgery, Hartford Hospital, Hartford, Connecticut, USA
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Lustig S, Mc Ewen P. Innovations in orthopaedics: Pioneering technique and technologies. J ISAKOS 2024; 9:757-758. [PMID: 38679159 DOI: 10.1016/j.jisako.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Sébastien Lustig
- Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Hospices Civils de Lyon, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
| | - Peter Mc Ewen
- Mater Hospital Pimlico, Townsville, Queensland, Australia
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Myrcha P, Siripurapu V, Gloviczki M, Dua A, Gloviczki P. Women Surgeons: Barriers and Solutions. Ann Vasc Surg 2024; 105:325-333. [PMID: 38599486 DOI: 10.1016/j.avsg.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/18/2024] [Accepted: 02/18/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Underrepresentation and undertreatment of women in surgery continues to be highly prevalent, with major barriers to improvement. The aim of the study was to review the current state of women surgeons in Poland. METHODS Information from the various Polish databases on women surgeons in 9 medical universities in general, oncological, vascular, thoracic, and cardiac surgery was retrospectively evaluated. Demographics of residents and staff surgeons, academic ranks and leadership positions at universities, in surgical societies and on scientific journals editorial boards were analyzed. Descriptive statistics were used. RESULTS In 2020, 61% of 3,668 graduates of Polish medical universities were women. In 5 surgical specialties, 11.9% (1,243 of 10,411) of the surgeons were women, with the lowest numbers in cardiac (5.6%), and in vascular surgery (6.4%); 40.4% of general surgery residents were women, less in vascular (18.4%) and thoracic surgery (24%), more in oncological surgery (28.7%). In 35 surgical departments of 9 universities, all department chairs were men, all full professors were men; 7% of associate professors and 16% of assistant professors were women. Rectors of all universities were men; 27% of the vice-rectors were women. In the senates and university councils, 39% and 35%, respectively, were women. Presidents, vice presidents, and secretaries of surgical societies and Editor-in-Chief of 4 surgical journals were all men. CONCLUSIONS Polish women surgeons face major difficulties with representation in surgery, in departmental, institutional, and societal leadership, and on scientific journal editorial boards. A multifaceted approach to correct these serious inequalities is urgently needed.
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Affiliation(s)
- Piotr Myrcha
- Depatment of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Vaishnavi Siripurapu
- East Carolina Brody School of Medicine, East Carolina University, Greenville, NC
| | - Monika Gloviczki
- Emeritus, The Department of Internal Medicine and Gonda Vascular Center, Mayo Clinic, Rochester, MN
| | - Anahita Dua
- Division of Vascular and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA.
| | - Peter Gloviczki
- Emeritus, Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN
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Chi C, Song X, Ma Y, Wang C, Zhu J. Establishment and Diagnostic Value of an Early Prediction Model for Acute Pancreatitis Complicated With Acute Kidney Injury. Pancreas 2024; 53:e547-e552. [PMID: 38986076 DOI: 10.1097/mpa.0000000000002325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVES To establish an early prediction model for acute pancreatitis (AP) complicated with acute kidney injury (AKI) and evaluate its diagnostic value. METHOD AP patients were recruited from the Emergency Department at Peking University People's Hospital in 2021 and stratified into AKI and control (no AKI) groups. Their clinical data were analyzed. The risk for AKI development was determined using logistic analyses to establish a risk prediction model, whose diagnostic value was analyzed using a receiver operating characteristic curve. RESULTS There was no significant difference in the basic renal function between the AKI (n = 79) and control (n = 179) groups. The increased triglyceride glucose index (odds ratio [OR], 2.613; 95% confidence interval [CI], 1.324-5.158; P = 0.006), age (OR, 1.076; 95% CI, 1.016-1.140; P = 0.013), and procalcitonin (OR, 1.377; 95% CI, 1.096-1.730, P = 0.006) were associated with AKI development. A model was established for prediction of AKI (sensitivity 79.75%, specificity 96.65%). The area under the receiver operating characteristic curve was 0.856 which was superior to the Ranson, Bedside Index for Severity in AP, and Acute Physiology and Chronic Health Evaluation II scores (0.856 vs 0.691 vs 0.745 vs 0.705). CONCLUSIONS The prediction model based on age, triglyceride glucose, and procalcitonin is valuable for the prediction of AP-related AKI.
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Affiliation(s)
- Cheng Chi
- From the Department of Emergency, Peking University People's Hospital, Beijing, China
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Angsuwatcharakon P, Kongkam P, Ridtitid W, Piyachaturawat P, Vongwattanakit P, Ananchuensook P, Faknak N, Vanduangden K, Rerknimitr R. Aberrant bile duct communicating with the cystic duct: From early detection to management of late surgical complications. Hepatobiliary Pancreat Dis Int 2024; 23:412-416. [PMID: 37353373 DOI: 10.1016/j.hbpd.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Affiliation(s)
- Phonthep Angsuwatcharakon
- Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Pradermchai Kongkam
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Wiriyaporn Ridtitid
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Panida Piyachaturawat
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Phuphat Vongwattanakit
- Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Prooksa Ananchuensook
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Natee Faknak
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Kunvadee Vanduangden
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Rungsun Rerknimitr
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Vicentini C, Ugliono E, Elhadidy HSMA, Paladini G, Cornio AR, Cussotto F, Morino M, Zotti CM. Surgical reorganization during the COVID-19 pandemic and impact on case-mix and surgical site infections: A multicenter cohort study in Italy. Health Policy 2024; 146:105113. [PMID: 38896918 DOI: 10.1016/j.healthpol.2024.105113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 02/27/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND The coronavirus 2019 (COVID-19) pandemic led to major disruptions in surgical activity, particularly in the first year (2020). The objective of this study was to assess the impact of surgical reorganization on surgical outcomes in Northern Italy in 2020 and 2021. METHODS A retrospective cohort study was conducted among 30 hospitals participating in the surveillance system for surgical site infections (SSIs). Abdominal surgery procedures performed between 2018 and 2021 were considered. Predicted SSI rates for 2020 and 2021 were estimated based on 2018-2019 data and compared with observed rates. Independent predictors for SSI were investigated using logistic regression, including procedure year. RESULTS 7605 procedures were included. Significant differences in case-mix were found comparing the three time periods. Observed SSI rates among all patients in 2020 were significantly lower than expected based on 2018-2019 SSI rates (p 0.0465). Patients undergoing procedures other than cancer surgery in 2020 had significantly lower odds for SSI (odds ratio, OR 0.52, 95 % confidence interval, CI 0.3-0.89, p 0.018) and patients undergoing surgery in 2021 had significantly higher odds for SSI (OR 1.49, 95 % CI 1.07-2.09, p 0.019) compared to 2018-2019. CONCLUSIONS Enhanced infection prevention and control (IPC) measures could explain the reduced SSI risk during the first pandemic year. IPC practices should continue to be reinforced beyond the pandemic context.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy.
| | - Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126 Turin, Italy
| | | | - Giovanni Paladini
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Alessandro Roberto Cornio
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Federico Cussotto
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Corso A.M. Dogliotti 14, 10126 Turin, Italy
| | - Carla Maria Zotti
- Department of Public Health and Paediatrics, University of Turin, Via Santena 5 bis, 10126, Turin, Italy
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Franklin KN, Nishtala M, McCracken A, Berian JR, Zarzaur B. Does delayed operation increase morbidity and mortality? An analysis of emergency general surgery procedures. J Trauma Acute Care Surg 2024; 97:266-271. [PMID: 38689389 PMCID: PMC11272423 DOI: 10.1097/ta.0000000000004339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Early operation is assumed to improve outcomes after emergency general surgery (EGS) procedures; however, few data exist to inform this opinion. We aimed to (1) characterize time-to-operation patterns among EGS procedures and (2) test the association between timing and patient outcomes. We hypothesize that patients receiving later operations are at greater risk for mortality and morbidity. METHODS We performed a retrospective cohort study of the American College of Surgeons National Surgical Quality Improvement Program data for adults aged 18 to 89 years who underwent nonelective intra-abdominal operations (appendectomy, cholecystectomy, small bowel resection, lysis of adhesions, and colectomy) from 2015 to 2020. The primary outcome was 30-day postoperative mortality. Secondary outcomes were serious morbidity and all morbidity. Admission-to-operation timing was calculated and classified as early (≤48 hours) or late (>48 hours). A multivariable logistic regression model adjusted risk estimates for age, comorbidities, frailty (Modified Frailty Index, 5-item score), and other confounders. RESULTS Of 269,959 patients (mean age, 47.0 years; 48.0% male, 61.6% White), 88.7% underwent early operation, ranging from 70.36% (lysis of adhesions) to 98.67% (appendectomy). Unadjusted 30-day mortality was higher for late versus early operation (6.73% vs. 1.96%; p < 0.0001). After risk adjustment, late operation significantly increased risk for 30-day mortality (odds ratio [OR], 1.545; 95% confidence interval [CI], 1.451-1.644), serious morbidity (OR, 1.464; 95% CI, 1.416-1.514), and all morbidity (OR, 1.468; 95% CI, 1.417-1.520). This mortality risk persisted for all EGS procedures; risk of serious and any morbidity persisted for all procedures except cholecystectomy. CONCLUSION Late operation significantly increased risk for 30-day mortality, serious morbidity, and all morbidity across a variety of EGS procedures. We believe that these findings will inform decisions regarding timing of EGS operations and allocation of surgical resources. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Kelsey N Franklin
- From the Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Liu M, Liu J, Wu J, Liu S, Sun L, Li F, Li C. A case report of empyema caused by Enterococcus gallinarum. BMC Infect Dis 2024; 24:769. [PMID: 39090541 PMCID: PMC11293086 DOI: 10.1186/s12879-024-09531-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/18/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Enterococcus gallinarum is an infrequently intestinal symbiotic pathogen associated with nosocomial infection in immunocompromised individuals. To date, rare cases of pulmonary infection attributable to Enterococcus gallinarum were reported. Herein, we presented the first case of empyema resulting from Enterococcus gallinarum infection. CASE PRESENTATION An 81-year-old male presented with fever and dyspnea upon admission. Chest CT scan and thoracic ultrasonography confirmed the presence of right pleural effusion. Thoracoscopy revealed extensive adhesion, purulent fluid, and necrotic materials within the thoracic cavity. Enterococcus gallinarum was identified through pleural effusion culture. The patient underwent an intrathoracic injection of urokinase along with thoracic drainage. Following surgery, He took oral linezolid for over one month. Undergoing comprehensive treatment, the patient exhibited favorable recovery. CONCLUSIONS We reported the first case of empyema due to Enterococcus gallinarum infection. It should be suspected in patients with impaired immune function and invasive therapies, without responding to conventional anti-infectious treatment.
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Affiliation(s)
- Min Liu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, No.168 Hongkong Road, Wuhan, 430000, Hubei, China
| | - Jixiang Liu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Beijing, 100029, China
| | - Juanjuan Wu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, No.168 Hongkong Road, Wuhan, 430000, Hubei, China
| | - Shuang Liu
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, No.168 Hongkong Road, Wuhan, 430000, Hubei, China
| | - Lu Sun
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, No 2, East Yinghua Road, Beijing, 100029, China
| | - Fajiu Li
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, No.168 Hongkong Road, Wuhan, 430000, Hubei, China.
| | - Chenghong Li
- Department of Pulmonary and Critical Care Medicine, Affiliated Hospital of Jianghan University, No.168 Hongkong Road, Wuhan, 430000, Hubei, China
- Institute of Pulmonary Vascular Diseases, Jianghan University, No.168 Hongkong Road, 430000, Wuhan, Hubei, China
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Lopes Vendrami C, Thorson DL, Borhani AA, Mittal PK, Hammond NA, Escobar DJ, Gabriel H, Recht HS, Horowitz JM, Kelahan LC, Wood CG, Nikolaidis P, Venkatesh SK, Miller FH. Imaging of Biliary Tree Abnormalities. Radiographics 2024; 44:e230174. [PMID: 39024175 DOI: 10.1148/rg.230174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Pathologic conditions of the biliary system, although common, can be difficult to diagnose clinically. Challenges in biliary imaging include anatomic variants and the dynamic nature of the biliary tract, which can change with age and intervention, blurring the boundaries of normal and abnormal. Choledochal cysts can have numerous appearances and are important to diagnose given the risk of cholangiocarcinoma potentially requiring surgical resection. Choledocholithiasis, the most common cause of biliary dilatation, can be difficult to detect at US and CT, with MRI having the highest sensitivity. However, knowledge of the imaging pitfalls of MRI and MR cholangiopancreatography is crucial to avoid misinterpretation. Newer concepts in biliary tract malignancy include intraductal papillary biliary neoplasms that may develop into cholangiocarcinoma. New paradigms in the classification of cholangiocarcinoma correspond to the wide range of imaging appearances of the disease and have implications for prognosis. Accurately staging cholangiocarcinoma is imperative, given expanding curative options including transplant and more aggressive surgical options. Infections of the biliary tree include acute cholangitis or recurrent pyogenic cholangitis, characterized by obstruction, strictures, and central biliary dilatation. Inflammatory conditions include primary sclerosing cholangitis, which features strictures and fibrosis but can be difficult to differentiate from secondary causes of sclerosing cholangitis, including more recently described entities such as immunoglobulin G4-related sclerosing cholangitis and COVID-19 secondary sclerosing cholangitis. The authors describe a wide variety of benign and malignant biliary tract abnormalities, highlight differentiating features of the cholangitides, provide an approach to interpretation based on the pattern of imaging findings, and discuss pearls and pitfalls of imaging to facilitate accurate diagnosis. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Camila Lopes Vendrami
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Deanna L Thorson
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Amir A Borhani
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Pardeep K Mittal
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Nancy A Hammond
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - David J Escobar
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Helena Gabriel
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Hannah S Recht
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Jeanne M Horowitz
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Linda C Kelahan
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Cecil G Wood
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Paul Nikolaidis
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Sudhakar K Venkatesh
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
| | - Frank H Miller
- From the Departments of Radiology (C.L.V., D.L.T., A.A.B., N.A.H., H.G., H.S.R., J.M.H., L.C.K., C.G.W., P.N., F.H.M.) and Pathology (D.J.E.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Ste 800, Chicago, IL 60611; Department of Radiology and Imaging, Medical College of Georgia, Augusta, Ga (P.K.M.); and Department of Radiology, Mayo Clinic College of Medicine, Rochester, Minn (S.K.V.)
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Yoon SJ, Hong SS, Jang KT, Yoon SK, Kim H, Shin SH, Heo JS, Kang CM, Kim KS, Hwang HK, Han IW. Predicting lymph node metastasis using preoperative parameters in patients with T1 ampulla of vater cancer. BMC Cancer 2024; 24:935. [PMID: 39090569 PMCID: PMC11293034 DOI: 10.1186/s12885-024-12311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/25/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Lymph node (LN) metastasis is an established prognostic factor for patients with surgically resected ampulla of Vater (AoV) cancer. The standard procedure for radical resection, including removal of regional LNs, is pancreaticoduodenectomy (PD); however, local excision has been considered as an alternative option for patients in the early stage cancer with significant comorbidities. In the present study, we elucidated the preoperative factors associated with LN metastasis to determine the appropriate surgical extent for T1 AoV cancer. METHODS We included patients who underwent surgery for T1 AoV cancer at Samsung Medical Center and Severance Hospital between 2000 and 2019. Risk factors were analyzed to identify the preoperative parameters associated with LN metastasis or regional LN recurrence during follow-up. Finally, using the identified risk factors, a prediction model was constructed. RESULTS Among 342 patients, 311 patients underwent PD, whereas 31 patients underwent transduodenal ampullectomy. Fourty-eight patients had LN metastasis according to pathology report, and two patients presented with regional LN recurrence. Age, carbohydrate antigen 19 - 9 (CA 19 - 9), and tumor differentiation were identified as factors associated with the increased risk of LN metastasis or regional LN recurrence. The area under the curve of the prediction model with these three factors was 0.728. CONCLUSION Our newly developed prediction model using age, CA 19 - 9, and tumor differentiation can help select patients who require PD over local excision. Nevertheless, additional in-depth analysis is warranted to select appropriate surgical extent for patients with presumed T1 AoV cancer.
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Affiliation(s)
- So Jeong Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Seung Soo Hong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Kyung Yoon
- Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hongbeom Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Sang Hyun Shin
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Kyung Sik Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea
| | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea.
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Korea.
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Paudel P, Agrawal S, Khatiwada B, Rai P, Karki S. Pedicled falciform ligament flap use as an alternative surgical technique in peptic ulcer perforation repair: a case report and review of literature. J Surg Case Rep 2024; 2024:rjae502. [PMID: 39149529 PMCID: PMC11324251 DOI: 10.1093/jscr/rjae502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/27/2024] [Indexed: 08/17/2024] Open
Abstract
Peptic ulcer disease (PUD) affects ~4 million people globally. Peptic ulcer perforation (PUP) is a serious complication of PUD associated with high mortality and morbidity. Hence, a high index of clinical suspicion is crucial in diagnosing such cases. Here, we present a case of a 19-year-old male who presented with 4 days of severe abdominal pain, fever, and vomiting. On examination, signs of acute abdomen were evident, and an erect chest X-ray confirmed free air under the diaphragm. The patient underwent an emergency midline laparotomy, during which 1000 ml of purulent fluid was evacuated. A perforation measuring 8 × 8 mm2 was repaired using the falciform ligament due to the unavailability of adequate healthy omentum. His postoperative recovery was uneventful. This case report underscores the importance of considering the falciform ligament as a viable and effective alternative for the closure of PUP when the omentum is unavailable.
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Affiliation(s)
- Pratiksha Paudel
- Department of Internal Medicine, All Nepal Hospital, Kathmandu 44600, Nepal
| | - Srikant Agrawal
- Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu 44600, Nepal
| | - Bidur Khatiwada
- Department of Internal Medicine, Nepalese Army Institute of Health Sciences, Kathmandu 44600, Nepal
| | - Prahasan Rai
- Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu 44600, Nepal
| | - Sijan Karki
- Department of Surgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu 44600, Nepal
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Masuda S, Imamura Y, Ichita C, Jinushi R, Kubota J, Kimura K, Makazu M, Sato R, Kako M, Kobayashi M, Uojima H, Taguri M, Orihara S, Koizumi K. Comparison of antimicrobial therapy termination in febrile and afebrile patients with acute cholangitis after drainage. Sci Rep 2024; 14:17858. [PMID: 39090409 PMCID: PMC11294559 DOI: 10.1038/s41598-024-68999-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 07/30/2024] [Indexed: 08/04/2024] Open
Abstract
The standard treatment duration for acute cholangitis (AC) involves a 4-7-day antimicrobial treatment post-biliary drainage; however, recent studies have suggested that a ≤ 2-3 days is sufficient. However, clinical practice frequently depends on body temperature as a criterion for discontinuing antimicrobial treatment. Therefore, in this study, we assessed whether patients with AC can achieve successful outcomes with a ≤ 7-day antimicrobial treatment, even with a fever, assuming the infection source is effectively controlled. We conducted a single-center retrospective study involving patients with AC, defined following the Tokyo Guidelines 2018 for any cause, who underwent successful biliary drainage and completed a ≤ 7-day antimicrobial treatment. Patients were categorized into the febrile and afebrile groups based on their body temperature within 24 h before completing antimicrobial treatment. The primary outcome was the clinical cure rate, defined as no initial presenting symptoms by day 14 post-biliary drainage without recurrence or death by day 30. The secondary outcome was a 3-month recurrence rate. Logistic regression with inverse probability of treatment weighting was used. Overall, 408 patients were selected, among whom 40 (9.8%) were febrile. The two groups showed no significant differences in the clinical cure and 3-month recurrence rates. Notably, the subgroups limited to patients with a ≤ 3-day antibiotic treatment duration also showed no differences in these outcomes. Therefore, our results suggest that discontinuing antibiotics within the initially planned treatment period was sufficient for successful drainage cases of AC, regardless of the patient's fever status during the 24 h leading up to termination.
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Affiliation(s)
- Sakue Masuda
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
| | - Yoshinori Imamura
- Division of Medical Oncology/Hematology, Department of Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, 650-0017, Japan
| | - Chikamasa Ichita
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ryuhei Jinushi
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama, 350-1298, Japan
| | - Jun Kubota
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Karen Kimura
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Makomo Makazu
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Ryo Sato
- Department of Gastroenterology, Saitama Medical University International Medical Center, Hidaka, Saitama, 350-1298, Japan
| | - Makoto Kako
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Masahiro Kobayashi
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
| | - Haruki Uojima
- Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Kamakura, Kanagawa, 252-0375, Japan
| | - Masataka Taguri
- Department of Health Data Science, Tokyo Medical University Graduate School of Medicine, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Shunichiro Orihara
- Department of Health Data Science, Tokyo Medical University Graduate School of Medicine, Shinjyuku-ku, Tokyo, 160-0023, Japan
| | - Kazuya Koizumi
- Department of Gastroenterology, Medicine Center, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan
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Nordness MF, Smith MC, Fogel J, Guillamondegui OD, Dennis BM, Gunter OL. Incidence of Endoscopic Retrograde Cholangiography after Subtotal Fenestrating and Reconstituting Cholecystectomy. J Am Coll Surg 2024; 239:145-149. [PMID: 38477475 PMCID: PMC11254557 DOI: 10.1097/xcs.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Laparoscopic subtotal cholecystectomy (SC) is used for the difficult cholecystectomy, but published experience with resource use for SC is limited. We hypothesized that the need for advanced resources are common after SC. STUDY DESIGN This was a retrospective review of laparoscopic cholecystectomies between 2017 and 2021 at a large center. SC cases were identified using a medical record tool. Baseline characteristics were assessed with Student's t -test and chi-square test. Primary outcome was endoscopic retrograde cholangiography (ERC) within 60 days. Secondary outcomes were reconstituted SC on postoperative ERC and length of stay (LOS). Uni- and multivariable logistic regression were used for binary outcomes. Multiple linear regression was used for LOS. Covariates included were age, sex, BMI, and American Society of Anesthesiology class. RESULTS A total of 1,222 laparoscopic cholecystectomies were performed between 2017 and 2021. Of these, 87 (7%) were SC. Male (p < 0.001) and older (p < 0.001) patients were more likely to undergo SC. Odds of postoperative ERC were higher in the SC group (odds ratio 9.79, 95% CI 5.90 to16.23, p < 0.001). There was no difference in preoperative ERC (17% vs 21%, p = 0.38). Reconstituting SC had lower odds of postoperative ERC (odds ratio 0.12, 95% CI 0.023 to 0.58, p = 0.009). LOS was 1.81 times higher in the SC group (p ≤ 0.001). Postoperative ERC was not associated with LOS (p = 0.24). CONCLUSIONS We present one of the largest single-center series of SC. Patients who underwent SC are more likely to be male, older, have higher American Society of Anesthesiology class, and have increased LOS. SC should be performed when access to ERC and interventional radiology is available. In the absence of these adjuncts, reconstituting SC decreases the need for early ERC, but long-term outcomes are unknown.
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Affiliation(s)
- Mina F. Nordness
- Division of Acute Care Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Michael C. Smith
- Division of Acute Care Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jessa Fogel
- Vanderbilt University Medical School, Nashville, TN
- Department of Orthopedic Surgery, University of Maryland, Baltimore, MD
| | - Oscar D. Guillamondegui
- Division of Acute Care Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Bradley M. Dennis
- Division of Acute Care Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Oliver L. Gunter
- Division of Acute Care Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
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Leiphrakpam PD, Newton R, Anaya DA, Are C. Evolution and current trends in the management of colorectal cancer liver metastasis. Minerva Surg 2024; 79:455-469. [PMID: 38953758 DOI: 10.23736/s2724-5691.24.10363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Metastatic colorectal cancer (mCRC) is a major cause of cancer-related death, with a 5-year relative overall survival of up to 20%. The liver is the most common site of distant metastasis in colorectal cancer (CRC), with about 50% of CRC patients metastasizing to their liver over the course of their disease. Complete liver resection is the primary modality of treatment for resectable colorectal cancer liver metastasis (CRLM), with an overall 5-year survival rate of up to 58%. However, only 15% to 20% of patients with CRLM are deemed suitable for resection at presentation. For unresectable diseases, the median survival of patients remains low even with the best chemotherapy. In recent decades, the management of CRLM has continued to evolve with the expansion of resection criteria, novel targeted systemic therapies, and improved locoregional therapies. However, due to the heterogeneity of the CRC patient population, the optimal evaluation of treatment options for CRLM remains complex. Therefore, effective management requires a multidisciplinary team to help define resectability and devise a personalized treatment approach, from the initial diagnosis to the final treatment.
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Affiliation(s)
- Premila D Leiphrakpam
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rachael Newton
- Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Chandrakanth Are
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA -
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Montravers P, Norrby-Teglund A, Munoz P. Treating necrotizing skin and soft-tissue infections. Intensive Care Med 2024; 50:1342-1345. [PMID: 38753269 DOI: 10.1007/s00134-024-07466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/24/2024] [Indexed: 08/09/2024]
Affiliation(s)
- Philippe Montravers
- Department of Anaesthesiology and Surgical Intensive Care, DMU PARABOL, APHP, Hôpital Bichat, 75018, Paris, France.
- UFR Paris Nord, Université Paris Cité, 75006, Paris, France.
- Université Paris Cité, INSERM UMR 1152 PHERE, 75018, Paris, France.
| | - Anna Norrby-Teglund
- Karolinska Institutet, Center for Infectious Medicine, Karolinska University Hospital, 141 52, Huddinge, Sweden
| | - Patricia Munoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES CB06/06/0058), Madrid, Spain
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Bogdanski AM, van Hooft JE, Boekestijn B, Bonsing BA, Wasser MNJM, Klatte DCF, van Leerdam ME. Aspects and outcomes of surveillance for individuals at high-risk of pancreatic cancer. Fam Cancer 2024; 23:323-339. [PMID: 38619782 PMCID: PMC11255004 DOI: 10.1007/s10689-024-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/24/2024] [Indexed: 04/16/2024]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer-related deaths and is associated with a poor prognosis. The majority of these cancers are detected at a late stage, contributing to the bad prognosis. This underscores the need for novel, enhanced early detection strategies to improve the outcomes. While population-based screening is not recommended due to the relatively low incidence of PDAC, surveillance is recommended for individuals at high risk for PDAC due to their increased incidence of the disease. However, the outcomes of pancreatic cancer surveillance in high-risk individuals are not sorted out yet. In this review, we will address the identification of individuals at high risk for PDAC, discuss the objectives and targets of surveillance, outline how surveillance programs are organized, summarize the outcomes of high-risk individuals undergoing pancreatic cancer surveillance, and conclude with a future perspective on pancreatic cancer surveillance and novel developments.
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Affiliation(s)
- Aleksander M Bogdanski
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Jeanin E van Hooft
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Bas Boekestijn
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin N J M Wasser
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Derk C F Klatte
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Monique E van Leerdam
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Ierardi AM, Lanza C, Calandri M, Filippiadis D, Ascenti V, Carrafiello G. ESR Essentials: image guided drainage of fluid collections-practice recommendations by the Cardiovascular and Interventional Radiological Society of Europe. Eur Radiol 2024:10.1007/s00330-024-10993-0. [PMID: 39090321 DOI: 10.1007/s00330-024-10993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024]
Abstract
This ESR Essentials article intends to provide detailed, step-by-step, information on the role of imaging in the diagnosis, procedural management, and follow-up of patients with fluid collections. Evidence-based medicine recommendations for the positioning of percutaneous drainages and/or for diagnostic/therapeutic aspiration of fluid collections are provided. Although medical history, clinical symptoms, physical examination, and laboratory tests can raise suspicions regarding a collection, an imaging assessment is usually necessary for the diagnosis. Radiologists can easily identify fluid collections that are clinically suspected by using a wide range of imaging modalities, such as ultrasound, CT, MRI, and cone-beam CT. Consequently, these imaging methods (either alone or combined), can be used to aspirate the collection or for the placement of a drainage catheter. The choice of imaging technique to be used is influenced by the location of the collection, operator preference, size, and content of the collection. In addition, it is of utmost importance to underline the role of the interventional radiologist in the management and follow-up of patients with percutaneous drains, in collaboration with surgeons, clinicians, and diagnostic radiologists. KEY POINTS: Indications for percutaneous imaging-guided drainage are supported by clinical findings, laboratory tests, and pre-procedural imaging. Deciding between aspiration or drain insertion should follow patient assessment and fluid collection characterization. The interventional radiologist should be part of the entire patient care process including follow-up.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Carolina Lanza
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Marco Calandri
- Department of Surgical Sciences, University of Torino, Via Genova 3, 10126, Turin, Italy
- Department of Diagnostic and Interventional Radiology, presidio Molinette, A.O.U. Città della salute e della scienza di Torino, Torino, Italy
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Velio Ascenti
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, Foundation IRCCS Cà Granda - Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, 20122, Milan, Italy
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71
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Julián-Jiménez A, Lorenzo Álvarez R, Gutiérrez Bueno V, Sánchez Trujillo M, Eduardo García D. [Early source control of infection in patients seen in the emergency department: a systematic review]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:323-333. [PMID: 38742536 PMCID: PMC11231492 DOI: 10.37201/req/027.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 04/05/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The term source (or focus) control encompasses all those physical measures that can be used to reduce the inoculum and modify those factors in the infectious medium that promote microbial growth or foreign antimicrobial defenses of the host. The main objective of this systematic review (SR) is to know and compare whether early detection and control of the focus (in less than 6 hours) in adult patients treated in the ED for severe infection or sepsis, compared to not controlling the focus or delayed focus control (more than 12 hours) is more effective and safer (improves clinical evolution, mortality, complications, hospital stay or need for ICU admission). METHODS A systematic review is carried out following the PRISMA regulations in the databases of PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov from January 2000 to December 31, 2023 without language restrictions and using a combination of MESH terms: "Source Control", "Early" "Infection OR Bacterial Infection OR Sepsis", "Emergencies OR Emergency OR Emergency Department" and "Adults". Observational cohort studies were included. No meta-analysis techniques were performed, but results were compared narratively. RESULTS A total of 1,658 articles were identified, of which 2 that met the inclusion criteria and were classified as high quality were finally analyzed. The included studies represent a total of 2,404 patients with 678 cases in which an intervention was performed to control the focus (28.20%). In the first study, 28-day mortality was lower in patients who underwent an intervention to control the focus (12.3% vs. 22.5%; P <0.001), with an adjusted HR of 0.538 (95% CI: 0.389-0.744; P<0.001). In the second, it was demonstrated that the time elapsed from when the patient was evaluated for the first time and was hemodynamically stabilized, until the start of surgery was associated with his survival at 60 days with an OR of 0.31 (95% CI: 0.19-0.45; P <0.0001). In fact, for each hour of delay an adjusted OR of 0.29 (95% CI: 0.16-0.47; P<0.0001) is established. So if the intervention is performed before 2 hours at 60 days, 98% of the patients are still alive, if it is performed between 2-4 hours it is reduced to 78%, if it is between 4-6 hours it drops to 55%, but if it is done for more than 6 hours there will be no survivors at 60 days. CONCLUSIONS This review shows that source control carried out after the evaluation of patients attending the ED reduces short-term mortality (30-60 days) and that it would be advisable to implement any required source control intervention as soon as possible, ideally early (within 6 hours).
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Affiliation(s)
- A Julián-Jiménez
- Dr. Agustín Julián-Jiménez, MD, PhD. Servicio de Urgencias-Coordinador de Docencia, Formación, Investigación y Calidad. Complejo Hospitalario Universitario de Toledo, Avda. Río Guadiana s/n. C.P: 45.071. Toledo. Spain.
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Mohr-Sasson A, Aycock M, Higgason N, Hui M, Bhalwal A, Jalloul R, Leon MG, Dziadek O, Montealegre A. Excess use of surgical supplies in minimally invasive benign gynecology surgery: an observational study. Am J Obstet Gynecol 2024; 231:273.e1-273.e7. [PMID: 38761838 DOI: 10.1016/j.ajog.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/13/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Single-use materials and equipment are regularly opened by the surgical team during procedures but left unused, potentially resulting in superfluous costs and excess environmental waste. OBJECTIVE This study aimed to estimate the excess use of surgical supplies in minimally invasive benign gynecologic surgeries. STUDY DESIGN This is a prospective observational study conducted at a university-affiliated single tertiary medical center. Designated study personnel were assigned to observe surgical procedures performed during July to September 2022. Surgical teams were observed while performing surgeries for benign indications. The teams were not informed of the purpose of the observation to avoid potential bias. Disposable materials and equipment opened during the procedure were documented. Excess supplies were defined as those opened but left unused before being discarded. Costs per item of the excess supplies were estimated on the basis of material and equipment costs provided by the hospital. RESULTS A total of 99 surgeries were observed, including laparoscopic (32%), robotic (39%), hysteroscopic (14%), vaginal (11%), and laparotomy procedures (3%). Excess use of surgical supplies was documented in all but one procedure. The total cost across all surgeries reached $6357. The contained tissue extraction bag was the most expensive item not used (Applied Medical, Rancho Santa Margarita, CA; $390 per unit) in 4 procedures, contributing 25.54% to the total cost. Raytec was the most common surgical waste, with a total of n=583 opened but unused (average n=5.95 per surgery). A significant difference was found in the rate of excess supplies across the surgical approaches, with robotic surgery contributing 52.19% of the total cost (P=.01). CONCLUSION Excess use of disposable materials and equipment is common in minimally invasive benign gynecologic surgeries and contributes to superfluous costs and excess environmental waste. It is predominantly attributed to the opening of inexpensive materials that are left unused during the procedure. Increased awareness of costs and generated waste may reduce excess use of surgical supplies and should be further explored in future research.
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Affiliation(s)
- Aya Mohr-Sasson
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Madison Aycock
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Noel Higgason
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mason Hui
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Asha Bhalwal
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Randa Jalloul
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mateo G Leon
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Olivia Dziadek
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Alvaro Montealegre
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
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Wieringa TH, León-García M, Espinoza Suárez NR, Hernández-Leal MJ, Jacome CS, Zisman-Ilani Y, Otten RHJ, Montori VM, Pieterse AH. The role of time in involving patients with cancer in treatment decision making: A scoping review. PATIENT EDUCATION AND COUNSELING 2024; 125:108285. [PMID: 38701622 DOI: 10.1016/j.pec.2024.108285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/28/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Time is often perceived as a barrier to shared decision making in cancer care. It remains unclear how time functions as a barrier and how it could be most effectively utilized. OBJECTIVE This scoping review aimed to describe the role of time in patient involvement, and identify strategies to overcome time-related barriers. METHODS Seven databases were searched for any publications on patient involvement in cancer treatment decisions, focusing on how time is used to involve patients, the association between time and patient involvement, and/or strategies to overcome time-related barriers. Reviewers worked independently and in duplicate to select publications and extract data. One coder thematically analyzed data, a second coder checked these analyses. RESULTS The analysis of 26 eligible publications revealed four themes. Time was a resource 1) to process the diagnosis, 2) to obtain/process/consider information, 3) for patients and clinicians to spend together, and 4) for patient involvement in making decisions. DISCUSSION Time is a resource throughout the treatment decision-making process, and generic strategies have been proposed to overcome time constraints. PRACTICE VALUE Clinicians could co-create decision-making timelines with patients, spread decisions across several consultations, share written information with patients, and support healthcare redesigns that allocate the necessary time.
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Affiliation(s)
- Thomas H Wieringa
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; VITAM - Center for Sustainable Health Research, Integrated University Health and Social Services Center of Capitale-Nationale, Quebec City, QC, Canada; Faculty of Nursing, Laval University, Quebec City, QC, Canada
| | - María José Hernández-Leal
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Department of Economics, Rovira i Virgili University, Tarragona, Spain; University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; Millennium Nucleus on Sociomedicine, 750908 Santiago, Chile
| | - Cristian Soto Jacome
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA; Division of Internal Medicine, Department of Medicine, Norwalk Hospital, Norwalk, CT, USA
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA; Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - René H J Otten
- Walaeus Library, Leiden University Medical Center, Leiden, the Netherlands
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands.
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Uwumiro F, Okpujie V, Ajiboye A, Abesin O, Ogunfuwa O, Mojeed O, Borowa A, Alemenzohu H, Hassan J, Ajayi O. Association between Insurance Status and Outcomes of Hospitalizations for Necrotizing Soft Tissue Infections. Surg Infect (Larchmt) 2024; 25:459-469. [PMID: 38985696 DOI: 10.1089/sur.2023.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024] Open
Abstract
Background: Lack of insurance is associated with poorer outcomes in hospitalized patients. However, few studies have explored this association in hospitalizations for necrotizing soft tissue infections (NSTIs). This study examined the impact of insurance status on the outcome of NSTI admissions. Methods: All adult hospitalizations for necrotizing fasciitis, gas gangrene, and Fournier gangrene between 2016 and 2018 were examined using the Nationwide Inpatient Sample database. Insurance status was categorized as insured (including Medicare, Medicaid, and Private, including Health maintenance organization (HMO) or uninsured (Self-pay). Outcome measures included mortality rates, limb loss, length of hospital stay, prolonged hospital stay, and critical care admissions. Statistical analysis included weighted sample analysis, chi-square tests, multivariate regression analysis, and negative binomial regression modeling. Results: Approximately 29,705 adult hospitalizations for NSTIs were analyzed. Of these, 57.4% (17,065) were due to necrotizing fasciitis, 22% (6,545) to gas gangrene, and 20.5% (6,095) to Fournier gangrene. Approximately 9.7% (2,875) were uninsured, whereas 70% (26,780) had insurance coverage. Among the insured, Medicare covered 39.6% (10,605), Medicaid 29% (7,775), and private insurance 31.4% (8,400). After adjustments, Medicare insurance was associated with greater odds of mortality (adjusted odds ratio [aOR]: 1.81; 95% confidence interval [CI]: 1.33-2.47; p = 0.001). Medicaid insurance was associated with increased odds of amputation (aOR: 1.81; 95% CI: 1.33-2.47; p < 0.001), whereas private insurance was associated with lower odds of amputation (aOR: 0.70; 95% CI: 0.51-0.97; p = 0.030). Medicaid insurance was associated with greater odds of prolonged hospital stay (aOR: 1.34; 95% CI: 1.09-1.64; p < 0.001). No significant association was observed between the lack of insurance or self-pay and the odds of primary or secondary outcomes. Conclusion: Medicare insurance was correlated with greater odds of mortality, whereas Medicaid insurance was associated with increased odds of amputation and longer hospital stay. Uninsured status was not associated with significant differences in NSTI outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Azabi Borowa
- College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Judith Hassan
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, Illinois, USA
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Rajme‐López S, Tello‐Mercado A, Ortíz‐Brizuela E, Martínez‐Guerra B, Tamez‐Torres K, Román‐Montes C, González‐Lara M, Ponce‐de‐León A. Clinical and Microbiological Characteristics of Febrile Neutropenia During Induction Chemotherapy in Adults With Acute Leukemia. Cancer Rep (Hoboken) 2024; 7:e2129. [PMID: 39158198 PMCID: PMC11331495 DOI: 10.1002/cnr2.2129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 05/30/2024] [Accepted: 06/30/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Few studies regarding infectious causes of febrile neutropenia (FN) in Mexico are available. AIMS We aimed to describe clinical and microbiological characteristics of FN episodes during induction chemotherapy in adults with acute leukemia. METHODS AND RESULTS This retrospective cohort from a Mexican tertiary care center included adults with newly diagnosed acute leukemia between January 2014, and December 2018. Clinical and microbiological characteristics were summarized using descriptive statistics. Univariate analyses for associations between clinical characteristics and FN and/or death were made; logistic regression analysis was performed to assess relationships with FN. Kaplan-Meier survival estimates were modeled for antimicrobial prophylaxis and FN. Ninety-five patients were included. Median age was 28 (IQR 20-43), 49 (52%) were males, and 74 (78%) developed FN (74/95). Among these, 98% had an identified source of infection (73/74) and 65% had >1. Common infections were urinary tract infection (24%), bacterial sinusitis (20%), and bacterial pneumonia (19%). Gram-negatives were the most frequently isolated microorganisms (69%), followed by Gram-positives (21%), and fungi (9%). Antimicrobial prophylaxis was inversely associated with FN (aOR = 0.07, CI 0.008-0.060, p = 0.02). Invasive fungal diseases were associated with 30-day mortality (aOR = 9.46, 95% CI 1.66-54.05). CONCLUSION Infections caused 98% of the FN episodes. Gram-negative bacteria are the most common pathogens.
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Affiliation(s)
- Sandra Rajme‐López
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Andrea C. Tello‐Mercado
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Edgar Ortíz‐Brizuela
- Internal Medicine DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Bernardo A. Martínez‐Guerra
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Karla M. Tamez‐Torres
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Carla M. Román‐Montes
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - María F. González‐Lara
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
- Clinical Microbiology LaboratoryInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Alfredo Ponce‐de‐León
- Infectious Diseases DepartmentInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
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Kunishima H, Ichiki K, Ohge H, Sakamoto F, Sato Y, Suzuki H, Nakamura A, Fujimura S, Matsumoto K, Mikamo H, Mizutani T, Morinaga Y, Mori M, Yamagishi Y, Yoshizawa S. Japanese Society for infection prevention and control guide to Clostridioides difficile infection prevention and control. J Infect Chemother 2024; 30:673-715. [PMID: 38714273 DOI: 10.1016/j.jiac.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases. St. Marianna University School of Medicine, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo Medical University Hospital, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Fumie Sakamoto
- Quality Improvement and Safety Center, Itabashi Chuo Medical Center, Japan
| | - Yuka Sato
- Department of Infection Control and Nursing, Graduate School of Nursing, Aichi Medical University, Japan
| | - Hiromichi Suzuki
- Department of Infectious Diseases, University of Tsukuba School of Medicine and Health Sciences, Japan
| | - Atsushi Nakamura
- Department of Infection Prevention and Control, Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases and Chemotherapy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | | | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Sadako Yoshizawa
- Department of Laboratory Medicine/Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Japan
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De Castro V, Galaine J, Loyon R, Godet Y. CRISPR-Cas gene knockouts to optimize engineered T cells for cancer immunotherapy. Cancer Gene Ther 2024; 31:1124-1134. [PMID: 38609574 DOI: 10.1038/s41417-024-00771-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024]
Abstract
While CAR-T and tgTCR-T therapies have exhibited noteworthy and promising outcomes in hematologic and solid tumors respectively, a set of distinct challenges remains. Consequently, the quest for novel strategies has become imperative to safeguard and more effectively release the full functions of engineered T cells. These factors are intricately linked to the success of adoptive cell therapy. Recently, CRISPR-based technologies have emerged as a major breakthrough for maintaining T cell functions. These technologies have allowed the discovery of T cells' negative regulators such as specific cell-surface receptors, cell-signaling proteins, and transcription factors that are involved in the development or maintenance of T cell dysfunction. By employing a CRISPR-genic invalidation approach to target these negative regulators, it has become possible to prevent the emergence of hypofunctional T cells. This review revisits the establishment of the dysfunctional profile of T cells before delving into a comprehensive summary of recent CRISPR-gene invalidations, with each invalidation contributing to the enhancement of engineered T cells' antitumor capacities. The narrative unfolds as we explore how these advancements were discovered and identified, marking a significant advancement in the pursuit of superior adoptive cell therapy.
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Affiliation(s)
- Valentine De Castro
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, F-25000, Besançon, France
| | - Jeanne Galaine
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, F-25000, Besançon, France
| | - Romain Loyon
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, F-25000, Besançon, France
| | - Yann Godet
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, F-25000, Besançon, France.
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Huang Y, Fu R, Liu D, Wen K. Keys to successful laparoscopic adhesiolysis for adhesive small bowel obstruction: A scoping review. Heliyon 2024; 10:e34359. [PMID: 39149046 PMCID: PMC11324824 DOI: 10.1016/j.heliyon.2024.e34359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024] Open
Abstract
Background Adhesive small bowel obstruction (ASBO) is a common acute abdominal complication. Although non-surgical treatment is the primary treatment approach, more and more studies show that surgical treatment can reduce the incidence rate. Laparoscopic adhesiolysis (LA) has many advantages of minimally invasive surgery.But not all patients with ASBO are suitable for LA. Objective The aim of this scoping review was to summarize the keys to successful LA by analyzing the extensive literature. Methods A literature search was conducted in PubMed for articles on laparoscopic treatment of ASBO published between January 2000 and February 2024. This scoping review followed the framework suggested by Arksey and O'Malley for a scoping review. Results By analyzing the included studies we found that LA does have many advantages and can be performed safely. However, the prerequisite is to select patients with simple adhesions whenever possible and to focus on reasonable intraoperative measures. To improve the success rate of LA, we summarized the following characteristics of patients: no contraindications related to pneumoperitoneum, few previous abdominal operations (≤2), no pregnancy, bowel dilatation < 4 cm in diameter, simple adhesions, no diffuse peritonitis, no history of abdominal radiotherapy, <24 h of ASBO, limited previous abdominal surgery (appendix, cholecystectomy), no bowel strangulation ischemia, and bowel necrosis or bowel resection required for other reasons. In addition, we also summarized reasonable intraoperative measures. Conclusions Laparoscopic adhesiolysis has many advantages.Specific patients can benefit from LA. This scoping review Summarized the conditions for patient screening and reasonable intraoperative measures with the aim of providing a reference for surgeons, thereby ensuring that more patients benefit from LA.
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Affiliation(s)
- Yuanqi Huang
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Ruimin Fu
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Dandan Liu
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Kunming Wen
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
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Ertekin SC, Cetindag O, Ergenç M, Yeğen C. Laparoscopic repair vs open repair for perforated peptic ulcers: Quality of life assessment. J Gastrointest Surg 2024:S1091-255X(24)00558-4. [PMID: 39089488 DOI: 10.1016/j.gassur.2024.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/09/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Studies reporting patient-centered outcomes, including quality of life and satisfaction, in perforated peptic ulcer (PPU) treatment are insufficient. This study was designed to assess the relative efficacy of laparoscopic repair (LR) as opposed to open surgical repair (OR) in the treatment of and its impact on quality of life. METHODS This investigation performed a retrospective review of patients who underwent treatment for PPU at a secondary care hospital between January 2017 and April 2020. Patients were categorized into 2 separate groups according to the type of surgical procedure received: LR and OR. Comparisons were made based on a variety of factors, such as demographic data, intra- and postoperative metrics, pain control, patient contentment, and quality of life indicators. RESULTS In the analysis, there were no statistically significant differences in demographic or clinical characteristics between the LR (n = 35) and OR (n = 62) groups (P > .05). Conversely, the rates of incisional hernia and surgical site infection were significantly greater in the OR group (P < .05). Moreover, the LR exhibited benefits such as a shorter length of hospital stay (P < .05), more rapid resumption of a normal diet, and fewer surgical site infections-factors that contributed to a lower rate of overall postoperative complications. According to the quality-of-life questionnaire, the LR group exhibited significantly greater scores for physical function, role, pain, and general health by the 30th postoperative day (P = .003, P < .001, P = .006, and P = .001, respectively), and by the 1-year follow-up, the LR group showed substantial improvements in physical function, physical role, emotional role, pain and general health (P = .047, P = .004, P = .039, P = .001, and P = .021, respectively), indicating its effectiveness in patient recovery and quality of life enhancement after surgery. CONCLUSION This study showed that LR could provide certain benefits in managing PPUs, such as reduced lengths of hospital stay and lower incidences of surgical site infections. Although LR reported promising directions in patient satisfaction and quality of life indicators, the limited duration of postoperative monitoring necessitates caution in broadly applying these results.
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Affiliation(s)
- Suleyman Caglar Ertekin
- Department of General Surgery, Altinbas University School of Medicine, Istanbul, Turkey; Department of General Surgery, Cekirge State Hospital, Bursa, Turkey
| | - Ozhan Cetindag
- Department of General Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, Izmir, Turkey
| | - Muhammer Ergenç
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey.
| | - Cumhur Yeğen
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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80
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Zewdu D, Tantu T, Eanga S, Tilahun T. Analgesic efficacy of erector spinae plane block versus transversus abdominis plane block for laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trial. Front Med (Lausanne) 2024; 11:1399253. [PMID: 39135713 PMCID: PMC11317285 DOI: 10.3389/fmed.2024.1399253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/11/2024] [Indexed: 08/15/2024] Open
Abstract
Background Although laparoscopic cholecystectomy (LC) is a minimally invasive surgery, it can cause moderate to severe postoperative pain. Erector spinae plane (ESP) and transversus abdominis plane (TAP) blocks are considered effective means for pain management in such cases; however, there is inconclusive evidence regarding their analgesic efficacy. This meta-analysis aimed to compare the efficacy of ESP block and TAP block for pain control in LC. Methods We systematically searched Medline, PubMed, Scopus, Embase, and Google Scholar until 26 January 2024. All randomized clinical trials compared the efficacy of erector spinae plane block (ESPB) and transversus abdominis plane block (TAPB) for postoperative pain relief after LC. The primary outcomes were pain scores at rest and on movement at 1, 2, 6, 12, and 24 h postoperatively. The secondary outcomes were total opioid consumption, first analgesia request time, and rates of postoperative nausea and vomiting. We analyzed all the data using RevMan 5.4. Results A total of 8 RCTs, involving 542 patients (271 in the ESPB group and 271 in the TAPB group), were included in the analysis. The ESP block demonstrated statistically significant lower pain scores at rest and on movement than the TAP block at all-time points except at the 1st and 6th h on movement postoperatively; however, these differences were not considered clinically significant. Additionally, patients who received the ESP block required less morphine and had a longer time before requesting their first dose of analgesia. There were no significant differences in postoperative nausea and vomiting incidence between the two groups. Conclusion In patients undergoing LC, there is moderate evidence to suggest that the ESP block is effective in reducing pain severity, morphine equivalent consumption, and the time before the first analgesia request when compared to the TAP block during the early postoperative period.Systematic review registration: PROSPERO CRD42024505635, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024505635.
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Affiliation(s)
- Dereje Zewdu
- Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Temesgen Tantu
- Department of Obstetrics and Gynecology, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Shamil Eanga
- Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Tamiru Tilahun
- Department of Anesthesia, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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81
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van Veelen MJ, Likar R, Tannheimer M, Bloch KE, Ulrich S, Philadelphy M, Teuchner B, Hochholzer T, Pichler Hefti J, Hefti U, Paal P, Burtscher M. Emergency Care for High-Altitude Trekking and Climbing. High Alt Med Biol 2024. [PMID: 39073038 DOI: 10.1089/ham.2024.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Introduction: High altitude regions are characterized by harsh conditions (environmental, rough terrain, natural hazards, and limited hygiene and health care), which all may contribute to the risk of accidents/emergencies when trekking or climbing. Exposure to hypoxia, cold, wind, and solar radiation are typical features of the high altitude environment. Emergencies in these remote areas place high demands on the diagnostic and treatment skills of doctors and first-aiders. The aim of this review is to give insights on providing the best possible care for victims of emergencies at high altitude. Methods: Authors provide clinical recommendations based on their real-world experience, complemented by appropriate recent studies and internationally reputable guidelines. Results and Discussion: This review covers most of the emergencies/health issues that can occur when trekking or during high altitude climbing, that is, high altitude illnesses and hypothermia, freezing cold injuries, accidents, for example, with severe injuries due to falling, cardiovascular and respiratory illnesses, abdominal, musculoskeletal, eye, dental, and skin issues. We give a summary of current recommendations for emergency care and pain relief in case of these various incidents.
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Affiliation(s)
- Michiel J van Veelen
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, SFU Vienna, Klagenfurt, Austria
| | - Markus Tannheimer
- Department of Sport and Rehabilitation Medicine, University of Ulm, Ulm, Germany
- Department of General and Visceral Surgery, ADK-Klinik Blaubeuren, Ulm, Germany
| | - Konrad E Bloch
- Department of Pulmonology, University Hospital of Zürich, Zürich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital of Zürich, Zürich, Switzerland
| | | | - Barbara Teuchner
- Department of Ophthalmology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | - Urs Hefti
- Swiss Sportclinic, Bern, Switzerland
- Medical Commission, International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
| | - Peter Paal
- Medical Commission, International Climbing and Mountaineering Federation (UIAA), Bern, Switzerland
- Department of Anaesthesiology and Intensive Care Medicine, St John of God Hospital, Paracelsus Medical University, Salzburg, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
- Austrian Society for Alpine- and High-Altitude Medicine, Innsbruck, Austria
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82
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Luitel P, Paudel S, Shrestha A, Gyawali P, Gaire R, Dev S. Acute mesenteric ischemia due to superior mesenteric artery thrombosis in a patient with protein S deficiency: A case report. Int J Surg Case Rep 2024; 122:110080. [PMID: 39088974 DOI: 10.1016/j.ijscr.2024.110080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/03/2024] Open
Abstract
INTRODUCTION Protein S deficiency resulting in mesenteric vein thrombosis has been reported in previous studies however those causing SMA thrombosis has been rarely reported. Multidisciplinary approach involving general surgeon, a vascular surgeon, an interventional radiologist, and an intensivist are crucial for management of SMA thrombosis. CASE PRESENTATION A 39-year-old non-smoker hypertensive female who was diagnosed with partially occlusive thrombus in the superior mesenteric artery via Contrast-enhanced computed tomography (CECT) re-presented after 5 days and CECT revealed a partially occlusive thrombus in the superior mesenteric artery and Protein S deficiency (free protein S:15 %). She was managed by lysis of thrombus with streptokinase by interventional radiology team. The patient is on anticoagulants and without abdominal complaints on follow-up at 24 months. DISCUSSION Computed tomography angiography should be done immediately in any patient suspected of AMI since delay in diagnosis accounts for high mortality rates of 30-70 %. The surgical treatment of the condition is well established and consists of revascularization and/or resection of nonviable bowel. Endovascular techniques have emerged as an alternative for occlusion of the SMA. Patients with protein C and/or S deficiency treated for AMI require lifelong anticoagulant/antiplatelet therapy to prevent relapse. CONCLUSION Hereditary thrombophilia should be suspected in young people with unusual thrombotic presentations. Earlier diagnosis and aggressive antithrombotic therapy in individuals with hypercoagulable states can improve outcomes. Treatment involving a multidisciplinary approach improves outcomes.
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Affiliation(s)
- Prajjwol Luitel
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Sujan Paudel
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Aron Shrestha
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal.
| | - Prashant Gyawali
- Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Roshan Gaire
- Department of Radiology, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Nepal
| | - Santosh Dev
- Department of General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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83
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Koo JGA, Liau MYQ, Kryvoruchko IA, Habeeb TAAM, Chia C, Shelat VG. Pancreatic pseudocyst: The past, the present, and the future. World J Gastrointest Surg 2024; 16:1986-2002. [PMID: 39087130 PMCID: PMC11287700 DOI: 10.4240/wjgs.v16.i7.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/19/2024] [Accepted: 06/17/2024] [Indexed: 07/22/2024] Open
Abstract
A pancreatic pseudocyst is defined as an encapsulated fluid collection with a well-defined inflammatory wall with minimal or no necrosis. The diagnosis cannot be made prior to 4 wk after the onset of pancreatitis. The clinical presentation is often nonspecific, with abdominal pain being the most common symptom. If a diagnosis is suspected, contrast-enhanced computed tomography and/or magnetic resonance imaging are performed to confirm the diagnosis and assess the characteristics of the pseudocyst. Endoscopic ultrasound with cyst fluid analysis can be performed in cases of diagnostic uncertainty. Pseudocyst of the pancreas can lead to complications such as hemorrhage, infection, and rupture. The management of pancreatic pseudocysts depends on the presence of symptoms and the development of complications, such as biliary or gastric outlet obstruction. Management options include endoscopic or surgical drainage. The aim of this review was to summarize the current literature on pancreatic pseudocysts and discuss the evolution of the definitions, diagnosis, and management of this condition.
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Affiliation(s)
- Jonathan GA Koo
- Department of General Surgery, Khoo Teck Puat Hospital, Singapore 768828, Singapore
| | - Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Igor A Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv 61022, Ukraine
| | - Tamer AAM Habeeb
- Department of General Surgery, Faculty of Medicine Zagazig University, Sharkia 44511, Egypt
| | - Christopher Chia
- Department of Gastroenterology, Woodlands General Hospital, Singapore 737628, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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84
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Nonaka K, Kawase K, Takagi K, Takatsu Y, Maniwa K, Takao C, Komura M, Mushika Y, Takeuchi N, Kato T, Kusakabe M, Kondo M. Development of Fournier's gangrene after chemotherapy for the recurrence of testicular cancer despite the absence of anorectal lesions: A case report. Medicine (Baltimore) 2024; 103:e38688. [PMID: 39058861 PMCID: PMC11272336 DOI: 10.1097/md.0000000000038688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/03/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Fournier's gangrene usually occurs when a specific bacterium intrudes into soft tissue, causing a wound or tumor. We encountered a patient with Fournier's gangrene due to severe myelosuppression after chemotherapy, despite the absence of an initial lesion on the anus and rectum. CASE PRESENTATION A 54-year-old man with a left testicular cancer recurrence had undergone chemotherapy. He had asymptomatic hepatitis and high hepatitis B virus DNA levels, which were normalized by administering tenofovir alafenamide fumarate. Twelve days after the start of chemotherapy, he complained of severe pain around the anus. The following day, he went into septic shock. Visual inspection showed dark purple skin discoloration on the left side of the anus. Laboratory data revealed severe neutropenia. Computed tomography showed a high density of soft tissue on the left side of the anus and gas bubbles in the left femoral ring. We diagnosed the patient with Fournier's gangrene due to a severe immunosuppressive state resulting from chemotherapy. We emergently removed necrotic tissue to the fullest extent possible. However, because the patient was in severe sepsis status, careful management in the intensive care unit was required for 32 days. After the first emergency operation, we performed several additional excisions. Finally, 391 days after the initial surgery, the patient was discharged from our hospital. The tumor has not recurred, and he is under outpatient observation in the urology department. CONCLUSION Fournier's gangrene should be considered in patients who are in a severe myelosuppressive state due to chemotherapy, have normal hepatitis B virus DNA levels but high hepatitis B surface antigen after tenofovir administration, complain of severe pain in the perianal area, and have a dark purple skin discoloration around the anus, despite having no initial anorectal lesions.
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Affiliation(s)
- Kenichi Nonaka
- Department of Digestive Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Kota Kawase
- Department of Urology, Daiyukai Daiichi Hospital, Ichinomiya, Aichi, Japan
| | - Kimiaki Takagi
- Department of Urology, Daiyukai Daiichi Hospital, Ichinomiya, Aichi, Japan
| | - Yuta Takatsu
- Department of Digestive Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Koji Maniwa
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Chika Takao
- Department of Digestive Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Minoru Komura
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Yoshinori Mushika
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Noriyuki Takeuchi
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Toshio Kato
- Department of Pathology, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Mitsuhiko Kusakabe
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
| | - Mitsutaka Kondo
- Department of Surgery, Daiyukai General Hospital, Ichinomiya, Aichi, Japan
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Shi Y, Zhao B, Zhou Y, Chen L, Su H, Gu J. Endovascular Revascularization versus Open Surgical Revascularization as the First Strategy for Arterial Acute Mesenteric Ischemia: A Systematic Review and Meta-analysis. J Vasc Surg 2024:S0741-5214(24)01655-0. [PMID: 39069018 DOI: 10.1016/j.jvs.2024.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/15/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE This paired meta-analysis aimed to compare the mortality and morbidity of endovascular revascularization (EVR) and open surgical revascularization (OSR) as the first strategy for arterial acute mesenteric ischemia (AMI). METHODS This systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. A systematic search strategy was performed to identify eligible studies using the following databases: PubMed, Embase, and Cochrane Library database from inception to December 31, 2023, with restriction to the English language, and the end search date was January 2, 2024. The primary outcome was short-term mortality. Secondary outcomes included bowel resection, second-look laparotomy, and short bowel syndrome (SBS). The counter-enhanced funnel plot and the Peters test were used to assess bias. Outcomes were reported as odds ratio (OR) with a 95% confidence interval (CI) using the Mantel-Haenszel method. The GRADE classification was utilized to estimate the certainty of evidence. RESULTS A total of 11 studies (1141 patients) comparing EVR versus OSR for arterial AMI were identified and analyzed. The mean age of 61.9 - 73.6 years and 45.1% of the patients were male. Compared with OSR, EVR as the first treatment may not reduce short-term mortality (OR 0.79; 95% CI, 0.50-1.25; p = 0.31; very low certainty) and second-look laparotomy (OR 1.00; 95% CI, 0.30-3.36; p = 0.99; very low certainty). However, EVR may be associated with reduced bowel resection (OR 0.42; 95% CI, 0.20-0.88; p = 0.022; very low certainty) and SBS (OR 0.39; 95% CI, 0.21-0.75; p = 0.005; very low certainty). The meta-regression revealed that the mortality regarding EVR versus OSR was not significantly impacted by thrombotic etiology (-0.002; 95% CI, -0.027 to 0.022, p = 0.85), whereas significantly impacted by the publication year (0.076; 95% CI, 0.069 to 0.145, p = 0.031). CONCLUSIONS Compared with OSR, EVR as the first treatment for arterial AMI may not reduce short-term mortality and second-look laparotomy. Future multicenter randomized controlled trials are urgently needed to confirm these results.
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Affiliation(s)
- Yadong Shi
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Boxiang Zhao
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Yangyi Zhou
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Liang Chen
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Haobo Su
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China
| | - Jianping Gu
- Department of Vascular and Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, China.
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Wei X, You L, Liu C, Xu X. Congenital absence of the gallbladder in a child: a case report. Front Pediatr 2024; 12:1440383. [PMID: 39132306 PMCID: PMC11310148 DOI: 10.3389/fped.2024.1440383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
Background Congenital absence of the gallbladder (CAGB) is an exceedingly rare embryological anomaly of the biliary system, with a complex etiology involving the failure of gallbladder formation during embryogenesis. Clinical manifestations are diverse; most patients are asymptomatic, while some present with symptoms such as biliary colic. The complexity of its clinical presentation and radiological features renders diagnosis challenging. Case presentation Fetal ultrasound at 22 weeks of gestation revealed an absent gallbladder. At 9 years and 11 months of age, the child exhibited significant weight gain and abnormalities. Abdominal ultrasound and magnetic resonance images demonstrated fatty liver and gallbladder agenesis. Liver function tests indicated mild abnormalities, with aspartate aminotransferase at 67 IU/L and alanine aminotransferase at 44 IU/L. Following 6 months of hepatoprotective and lipid-lowering therapy, a satisfactory treatment response was achieved, with normalization of liver function and improvement in fatty liver. Conclusions CAGB may be associated with other congenital abnormalities, although isolated cases are uncommon. Clinically, it may manifest as nonspecific biliary, gastrointestinal, or urinary symptoms, mimicking various digestive disorders and leading to misdiagnosis. Genetic sequencing and in-depth embryological research may elucidate the etiology and enhance diagnostic accuracy.
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Affiliation(s)
| | | | | | - Xu Xu
- Department of General Medicine of Ganmei Hospital, Affiliated to Kunming Medical University (Kunming First People’s Hospital), Kunming, Yunnan, China
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Endo Y, Tsilimigras DI, Munir MM, Woldesenbet S, Guglielmi A, Ratti F, Marques HP, Cauchy F, Lam V, Poultsides GA, Kitago M, Alexandrescu S, Popescu I, Martel G, Gleisner A, Hugh T, Aldrighetti L, Shen F, Endo I, Pawlik TM. Machine learning models including preoperative and postoperative albumin-bilirubin score: short-term outcomes among patients with hepatocellular carcinoma. HPB (Oxford) 2024:S1365-182X(24)02227-5. [PMID: 39098450 DOI: 10.1016/j.hpb.2024.07.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/03/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND We sought to assess the impact of various perioperative factors on the risk of severe complications and post-surgical mortality using a novel maching learning technique. METHODS Data on patients undergoing resection for HCC were obtained from an international, multi-institutional database between 2000 and 2020. Gradient boosted trees were utilized to construct predictive models. RESULTS Among 962 patients who underwent HCC resection, the incidence of severe postoperative complications was 12.7% (n = 122); in-hospital mortality was 2.9% (n = 28). Models that exclusively used preoperative data achieved AUC values of 0.89 (95%CI 0.85 to 0.92) and 0.90 (95%CI 0.84 to 0.96) to predict severe complications and mortality, respectively. Models that combined preoperative and postoperative data achieved AUC values of 0.93 (95%CI 0.91 to 0.96) and 0.92 (95%CI 0.86 to 0.97) for severe morbidity and mortality, respectively. The SHAP algorithm demonstrated that the factor most strongly predictive of severe morbidity and mortality was postoperative day 1 and 3 albumin-bilirubin (ALBI) scores. CONCLUSION Incorporation of perioperative data including ALBI scores using ML techniques can help risk-stratify patients undergoing resection of HCC.
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Affiliation(s)
- Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Diamantis I Tsilimigras
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad M Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | - François Cauchy
- Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Vincent Lam
- Department of Surgery, Westmead Hospital, Sydney, NSW, Australia
| | | | - Minoru Kitago
- Department of Surgery, Keio University, Tokyo, Japan
| | | | - Irinel Popescu
- Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Ana Gleisner
- Department of Surgery, University of Colorado, Denver, CO, USA
| | - Tom Hugh
- Department of Surgery, School of Medicine, The University of Sydney, Sydney, NSW, Australia
| | | | - Feng Shen
- Department of Hepatic Surgery IV, the Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Itaru Endo
- Yokohama City University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Pickles K, Haas R, Guppy M, O'Connor DA, Pathirana T, Barratt A, Buchbinder R. Clinician and health service interventions to reduce the greenhouse gas emissions generated by healthcare: a systematic review. BMJ Evid Based Med 2024:bmjebm-2023-112707. [PMID: 38782560 DOI: 10.1136/bmjebm-2023-112707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To synthesise the available evidence on the effects of interventions designed to improve the delivery of healthcare that reduces the greenhouse gas (GHG) emissions of healthcare. DESIGN Systematic review and structured synthesis. SEARCH SOURCES Cochrane Central Register of Controlled Trials, PubMed, Web of Science and Embase from inception to 3 May 2023. SELECTION CRITERIA Randomised, quasi-randomised and non-randomised controlled trials, interrupted time series and controlled or uncontrolled before-after studies that assessed interventions primarily designed to improve the delivery of healthcare that reduces the GHG emissions of healthcare initiated by clinicians or healthcare services within any setting. MAIN OUTCOME MEASURES Primary outcome was GHG emissions. Secondary outcomes were financial costs, effectiveness, harms, patient-relevant outcomes, engagement and acceptability. DATA COLLECTION AND ANALYSIS Paired authors independently selected studies for inclusion, extracted data, and assessed risk of bias using a modified checklist for observational studies and the certainty of the evidence using Grades of Recommendation, Assessment, Development and Evaluation. Data could not be pooled because of clinical and methodological heterogeneity, so we synthesised results in a structured summary of intervention effects with vote counting based on direction of effect. RESULTS 21 observational studies were included. Interventions targeted delivery of anaesthesia (12 of 21), waste/recycling (5 of 21), unnecessary test requests (3 of 21) and energy (1 of 21). The primary intervention type was clinician education. Most (20 of 21) studies were judged at unclear or high risk of bias for at least one criterion. Most studies reported effect estimates favouring the intervention (GHG emissions 17 of 18, costs 13 of 15, effectiveness 18 of 20, harms 1 of 1 and staff acceptability 1 of 1 studies), but the evidence is very uncertain for all outcomes (downgraded predominantly for observational study design and risk of bias). No studies reported patient-relevant outcomes other than death or engagement with the intervention. CONCLUSIONS Interventions designed to improve the delivery of healthcare that reduces GHG emissions may reduce GHG emissions and costs, reduce anaesthesia use, waste and unnecessary testing, be acceptable to staff and have little to no effect on energy use or unintended harms, but the evidence is very uncertain. Rigorous studies that measure GHG emissions using gold-standard life cycle assessment are needed as well as studies in more diverse areas of healthcare. It is also important that future interventions to reduce GHG emissions evaluate the effect on beneficial and harmful patient outcomes. PROSPERO REGISTRATION NUMBER CRD42022309428.
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Affiliation(s)
- Kristen Pickles
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
| | - Romi Haas
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michelle Guppy
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Denise A O'Connor
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thanya Pathirana
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
- Griffith University School of Medicine and Dentistry, Gold Coast, Queensland, Australia
| | - Alexandra Barratt
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
- Healthy Environments and Lives (HEAL) National Research Network, Canberra, Victoria, Australia
| | - Rachelle Buchbinder
- Wiser Healthcare Research Collaboration, Sydney, New South Wales, Australia
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Fernandez-Alvarez MDM, Cachero-Rodríguez J, Fu MR, Sánchez-Fernández P, Ureña-Lorenzo A, Martin-Payo R. YouTube videos on lymphedema as an information source for Spanish speaking breast cancer survivors. Support Care Cancer 2024; 32:540. [PMID: 39044016 PMCID: PMC11266410 DOI: 10.1007/s00520-024-08746-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 07/15/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Breast cancer-related lymphedema in the upper limb remains one of the most distressful complications of breast cancer treatment. YouTube is considered a potential digital resource for population health and decision making. However, access to inadequate information or misinformation could have undesirable impacts. This cross-sectional study aimed to evaluate the reliability, quality and content of YouTube videos on lymphedema as an information source for Spanish-speaking breast cancer survivors. METHODS A search of YouTube was conducted in January 2023 using the key words "breast cancer lymphedema" and "lymphedema arm breast cancer." Reliability and quality of the videos were evaluated using the Discern tool, content, source of production, number of likes, comments, views, duration, Video Power Index, likes ratio, view ratio and age on the platform. RESULTS Amongst the 300 Spanish language videos identified on YouTube, 35 were selected for analysis based on the inclusion and exclusion criteria. Of the 35 selected videos, 82.9% (n = 29) were developed by healthcare or academic professionals and 17.1% (n = 9) by others. Reliability (p < 0.017) and quality (p < 0.03) were higher in the videos made by professionals. The Discern total score (r = 0.476; p = 0.004), reliability (r = 0.472; p = 0.004) and quality (r = 0.469; p = 0.004) were positively correlated with the duration of the videos. CONCLUSIONS Our findings provide a strong rationale for educating breast cancer survivors seeking lymphedema information to select videos made by healthcare or academic professionals. Standardised evaluation prior to video publication is needed to ensure that the end-users receive accurate and quality information from YouTube.
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Affiliation(s)
- Maria Del Mar Fernandez-Alvarez
- Facultad de Medicina y Ciencias de La Salud, Universidad de Oviedo, Campus del Cristo S/N, 33006 - Oviedo, Asturias, Spain
- Equipo de Investigación Precam, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
| | - Judit Cachero-Rodríguez
- Facultad de Medicina y Ciencias de La Salud, Universidad de Oviedo, Campus del Cristo S/N, 33006 - Oviedo, Asturias, Spain.
- Equipo de Investigación Precam, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain.
| | - Mei Rosemary Fu
- The Dorothy and Dale Thompson Missouri Endowed Professor in Nursing and Associate Dean for Research, University of Missouri-Kansas City, School of Nursing and Health Studies, Kansas City, MO, USA
| | - Paula Sánchez-Fernández
- Facultad de Medicina y Ciencias de La Salud, Universidad de Oviedo, Campus del Cristo S/N, 33006 - Oviedo, Asturias, Spain
| | | | - Ruben Martin-Payo
- Facultad de Medicina y Ciencias de La Salud, Universidad de Oviedo, Campus del Cristo S/N, 33006 - Oviedo, Asturias, Spain
- Equipo de Investigación Precam, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Asturias, Spain
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90
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Li Z, Zhou L, Li M, Wang W, Wang L, Dong W, Chen J, Gong S. Early mobilization after pancreatic surgery: A randomized controlled trial. Surgery 2024:S0039-6060(24)00450-1. [PMID: 39054183 DOI: 10.1016/j.surg.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/02/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Pancreatic surgery has long been burdened with high postoperative morbidity. Early mobilization has been advocated to prevent complications and improve functional capacity. However, there is a lack of high-quality evidence supporting how to implement early mobilization and its independent impact on postoperative outcomes. The aim of this study was to investigate the effectiveness of implementing early mobilization in reducing postoperative complications and enhancing recovery in patients undergoing pancreatic surgery. METHODS We conducted a single-blind, randomized trial in patients who underwent pancreatic surgery in a tertiary hospital in China. Eligible participants were randomly assigned to either the control group or the intervention group. Patients in the control group received usual care, whereas those in the intervention group received the early enforced mobilization protocol. The protocol consisted of 2 key components: professional assistance with the first ambulation on postoperative day 1 and family-involved supervision to achieve daily walking goals. The primary outcome was postoperative complications within 30 days, measured by the Comprehensive Complication Index. Secondary outcomes were postoperative mobilization, time to recovery of gastrointestinal function, postoperative pulmonary complications, pancreatic surgery-specific complications, patient-reported outcome measures, and 30-day readmission and mortality. RESULTS A total of 135 patients were enrolled: 67 in the intervention group and 68 in the control group. The median Comprehensive Complication Index was not statistically significant between groups (mean difference -1.7; 95% confidence interval -8.7 to 0). Patients in the intervention group had earlier first ambulation postoperatively, walked greater distances on postoperative days 1-7, and had earlier time to first defecation. Trends for improvement in patient-reported outcomes showed that scores of Quality of Recovery 15 at postoperative day 3, physical function of Quality of Life Questionnaire C30 at postoperative day 7, and global quality of life at postoperative day 30 were significantly greater in the intervention group. There was no between-group difference in other domains of the Quality of Life Questionnaire C30 or other secondary outcome measures. CONCLUSION Early enforced mobilization intervention did not reduce postoperative complications of patients undergoing pancreatic surgery, but it can enhance postoperative mobilization and improve the recovery of gastrointestinal function and patient-perceived quality of recovery.
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Affiliation(s)
- Zhi Li
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Lili Zhou
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Meixia Li
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Wei Wang
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Lisheng Wang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wenwen Dong
- Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China
| | - Juan Chen
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shu Gong
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan Province, China.
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Cocker D, Birgand G, Zhu N, Rodriguez-Manzano J, Ahmad R, Jambo K, Levin AS, Holmes A. Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions. Nat Rev Microbiol 2024:10.1038/s41579-024-01076-4. [PMID: 39048837 DOI: 10.1038/s41579-024-01076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.
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Affiliation(s)
- Derek Cocker
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - Gabriel Birgand
- Centre d'appui pour la Prévention des Infections Associées aux Soins, Nantes, France
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Cibles et medicaments des infections et de l'immunitée, IICiMed, Nantes Universite, Nantes, France
| | - Nina Zhu
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jesus Rodriguez-Manzano
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Raheelah Ahmad
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Health Services Research & Management, City University of London, London, UK
- Dow University of Health Sciences, Karachi, Pakistan
| | - Kondwani Jambo
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anna S Levin
- Department of Infectious Disease, School of Medicine & Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Alison Holmes
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK.
- Department of Infectious Disease, Imperial College London, London, UK.
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Loudon AM, Landwehr HJ, Hinton JB, Posluszny JA, Radow BS, Moorman ML. Optimal Management of Traumatic Abdominal Wall Hernias Remains Unclear. Am Surg 2024:31348241268016. [PMID: 39042944 DOI: 10.1177/00031348241268016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
High-energy, blunt force trauma to the abdomen results in an abdominal wall injury (AWI) in up to 9% of patients. In 1% of blunt abdominal trauma, they result in a traumatic abdominal wall hernia (TAWH). Optimal management of these injuries remains unclear. Because they are the result of a high-energy mechanism, concomitant serious abdominal organ injuries are common. This has prompted some to advocate that the presence of a TAWH on physical exam mandates exploratory laparotomy. However, delayed repairs have better outcomes and nontherapeutic celiotomy should be avoided. Similarly debated is the expanding use of minimally invasive techniques and the use of mesh for hernia repairs. Overall, the presence of a TAWH is likely not an absolute indication for emergency surgery. Rather, it is an indicator of high-energy impact and associated with a high rate of visceral injury. These patients require a close observation for clinical decline and development of typical indicators for laparotomy.
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Affiliation(s)
- Andrew M Loudon
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | | | | | - Joseph A Posluszny
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Brandon S Radow
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Matthew L Moorman
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
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Song H, Zhao H, Wang W, Li S. Integration analysis of miRNA-mRNA uncovers the molecular immune mechanism of macrophage response to Aeromonas veronii infection. Microb Pathog 2024; 194:106820. [PMID: 39047803 DOI: 10.1016/j.micpath.2024.106820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 06/19/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
Macrophages are innate immunity cells which play pivotal roles in infectious immunity. Aeromonas veronii is a zoonotic agent capable of causing sepsis and poses a serious threat to public health. However, few studies have focused on miRNA-mRNA integration analysis to address the immune mechanisms of macrophage response to A. veronii infection. Herein, we characterized the immunophysiological, biochemical, and transcriptome changes of macrophage under A. veronii infection. We found that macrophages infected with A. veronii released large amounts of cytokines and triggered NLRP3-dependent pyroptosis. Subsequently, 603 differentially expressed miRNAs (DEMIs) and 3693 differentially expressed mRNAs (DEMs) were identified by RNA-seq analysis under A. veronii infection. Moreover, integrated analysis of miRNA-mRNA yielded 66 miRNA-target gene pairs composed of 41 DEMIs and 27 DEMs. We next identified the Toll-like receptor, NOD-like receptor, TNF and NF-κB pathways as necessary for macrophage to respond to A. veronii infection. miR-847 and miR-627 were involved in macrophage response to A. veronii infection by negatively regulating Pannexin-1 and thioredoxin interacting protein (TXNIP). Our findings elucidate the molecular mechanism of macrophage response to A. veronii infection at the miRNA level, providing many candidate miRNAs and mRNAs therapeutic targets for the prevention and treatment of A. veornii infectious diseases.
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Affiliation(s)
- Haichao Song
- Marine College, Shandong University, Weihai, Shandong Province, 264209, PR China
| | - Han Zhao
- College of Veterinary Medicine, Jilin Agricultural University, Changchun, Jilin Province, 130118, PR China
| | - Wenfeng Wang
- Ziguang Technology Park Co., Ltd, Weihai, Shandong Provience, 264206, PR China
| | - Shu Li
- Marine College, Shandong University, Weihai, Shandong Province, 264209, PR China.
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Kamara IF, Fofanah BD, Nuwagira I, Kamara KN, Tengbe SM, Abiri O, Kamara RZ, Lakoh S, Farma L, Kamara AK, Hailu B, Dove D, Squire JS, D'Almeida SA, Sheriff B, Mustapha A, Bawa N, Lagesse H, Koroma AT, Kanu JS. Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study. Antimicrob Resist Infect Control 2024; 13:80. [PMID: 39039593 PMCID: PMC11265072 DOI: 10.1186/s13756-024-01425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 06/14/2024] [Indexed: 07/24/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone. METHODS This was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children's Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22. RESULTS Both ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% - 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription. CONCLUSION The non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone.
- Reproductive maternal newborn child and adolescent health unit, Universal Health Coverage, Life Course Cluster, WHO Country Office in Sierra Leone, Freetown, Sierra Leone.
| | - Bobson Derrick Fofanah
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Innocent Nuwagira
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Kadijatu Nabie Kamara
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Sia Morenike Tengbe
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Onome Abiri
- Pharmacy Board Sierra Leone, New England Ville, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- United States Centers for Disease Control and Prevention Country Office, Emergency Operation Centre, Wilkinson Road, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Lynda Farma
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Abibatu Kollia Kamara
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Binyam Hailu
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Djossaya Dove
- Department of Demographic and Social Statistics, National Institute of Statistics, Yaoundé, Cameroon
| | | | - Selassi A D'Almeida
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Reproductive Maternal Newborn Child and Adolescent Unit, Universal Health Coverage, Life Course Cluster, World Health Organization Country Office, 21 A-B Riverside Off Kingharman Road, Freetown, Sierra Leone
| | - Ayeshatu Mustapha
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
| | - Najima Bawa
- Momentum Country and Global Leadership, Sir Samuel Lewis Road, Freetown, Sierra Leone
| | - Hailemariam Lagesse
- United Nation Children's Fund, Jomo Kenyatta Road, New England Ville, Freetown, Sierra Leone
| | | | - Joseph Sam Kanu
- Ministry of Health, Fourth Floor, Youyi Building, Brookfields, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Kvist M, Jensen TK, Snitkjær C, Burcharth J. The clinical consequences of burst abdomen after emergency midline laparotomy: a prospective, observational cohort study. Hernia 2024:10.1007/s10029-024-03104-x. [PMID: 39031235 DOI: 10.1007/s10029-024-03104-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/25/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE The emergency midline laparotomy is a commonly performed procedure with a burst abdomen being a critical surgical complication requiring further emergency surgery. This study aimed to investigate the clinical outcomes of patients with burst abdomen after emergency midline laparotomy. METHODS A single-center, prospective, observational cohort study of patients undergoing emergency midline laparotomy during a two-year period was done. Abdominal wall closure followed a standardized technique using monofilament, slowly absorbable suture in a continuous suturing technique with a suture-to-wound ratio of at least 4:1. Treatment of burst abdomen was surgical. Data, including intra-hospital postoperative complications, were collected and registered chronologically based on journal entries. The primary outcome was to describe postoperative complications, length of stay, and the overall morbidity based on the Comprehensive Complication Index (CCI), stratified between patients who did and did not suffer from a burst abdomen during admission. RESULTS A total of 543 patients were included in the final cohort, including 24 patients with burst abdomen during admission. The incidence of burst abdomen after emergency midline laparotomy was 4.4%. Patients with a burst abdomen had a higher total amount of complications per patient (median of 3, IQR 1.3-5.8 vs. median of 1, IQR 0.0-3.0; p = 0.001) and a significantly higher CCI (median of 53.0, IQR 40.3-94.8 vs. median of 21.0, IQR 0.0-42.0; p = < 0.001). CONCLUSION Patients with burst abdomen had an increased risk of postoperative complications during admission as well as a longer and more complicated admission with multiple non-surgical complications.
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Affiliation(s)
- Madeline Kvist
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital - Herlev and Gentofte Herlev, Herlev, Denmark.
| | - Thomas Korgaard Jensen
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital - Herlev and Gentofte Herlev, Herlev, Denmark
| | - Christian Snitkjær
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital - Herlev and Gentofte Herlev, Herlev, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Emergency Surgery Research Group Copenhagen (EMERGE Cph), Copenhagen University Hospital - Herlev and Gentofte Herlev, Herlev, Denmark
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Luo Q, Teng X, Dai M, Yang J, Cheng W, Chen K, Zhou L. Global trends in the application of fluorescence imaging in pancreatic diseases: a bibliometric and knowledge graph analysis. Front Oncol 2024; 14:1383798. [PMID: 39099697 PMCID: PMC11294181 DOI: 10.3389/fonc.2024.1383798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/01/2024] [Indexed: 08/06/2024] Open
Abstract
Background In recent years, with the continuous development of fluorescence imaging technology, research on its application in pancreatic diseases has surged. This area is currently of high research interest and holds the potential to become a non-invasive and effective tool in the diagnosis and treatment of pancreatic diseases. The objective of this study is to explore the hotspots and trends in the field of fluorescence imaging technology applications in pancreatic diseases from 2003 to 2023 through bibliometric and visual analysis. Methods This study utilized the Web of Science (core collection) to identify publications related to the application of fluorescence imaging technology in pancreatic diseases from 2003 to 2023. Tools such as CiteSpace (V 6.2.R6), VOSviewer (v1.6.20), and R Studio (Bibliometrix: R-tool version 4.1.4) were employed to analyze various dimensions including publication count, countries, institutions, journals, authors, co-cited references, keywords, burst words, and references. Results A comprehensive analysis was conducted on 913 papers published from January 1, 2003, to December 1, 2023, on the application of fluorescence imaging technology in pancreatic diseases. The number of publications in this field has rapidly increased, with the United States being the central hub. The University of California, San Diego emerged as the most active institution. "Biomaterials" was identified as the most influential journal. Authors with the most publications and the highest average citations per article are Hoffman, Robert M. and Luiken, George A., respectively. Keywords such as pancreatic cancer, cancer, expression, indocyanine green, and nanoparticles received widespread attention, with indocyanine green and nanoparticles being current active research hotspots in the field. Conclusion This study is the first bibliometric analysis in the field of fluorescence imaging technology applications in pancreatic diseases. Our data will facilitate a better understanding of the developmental trends, identification of research hotspots, and direction in this field. The findings provide practical information for other scholars to grasp key directions and cutting-edge insights.
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Affiliation(s)
- Quanneng Luo
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Xiong Teng
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - ManXiong Dai
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Jun Yang
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Wei Cheng
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
- Hunan Schistosomiasis Control Center (Hunan Third People’s Hospital), Yueyang, Hunan, China
| | - Kang Chen
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Lei Zhou
- Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
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97
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Sun Y, Zhang P, Zhang D. Impact of treatment delays on future survival outcomes in non-surgical patients with esophageal cancer in Shandong Province, China. Front Oncol 2024; 14:1445267. [PMID: 39099688 PMCID: PMC11294235 DOI: 10.3389/fonc.2024.1445267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/08/2024] [Indexed: 08/06/2024] Open
Abstract
The treatment process of tumors in surgical patients is typically prompt and efficient, whereas non-surgical patients are more prone to treatment delay due to various factors. However, the relationship between treatment delay and survival outcomes in non-surgical Esophageal cancer (EC) patients has received limited study. This study aims to evaluate the impact of waiting time from diagnose to treatment on survival outcomes among non-surgical EC patients in Shandong Province, China. Over a 20-year follow-up period, a total of 12,911 patients diagnosed with EC and not receiving surgical intervention were identified from 2000 to 2020. The Kaplan-Meier methodology was employed to determine overall survival (OS) and cancer-specific survival (CSS). Univariate and multivariate Cox regression analyses were performed to evaluate the impact of treatment delays on future outcomes. The nonlinear association between waiting time and survival outcomes was investigated using restricted cubic spline (RCS) functions. The average delay in initiating EC treatment from the initial medical consultation for symptoms of EC was 1.18 months (95%CI=1.16-1.20). Patients with a long delay (≥3 months) in treatment demonstrated significantly lower rates of 1-, 3-, and 5-year OS and CSS compared to those with a brief delay in treatment initiation. A long delay in EC treatment independently associated with an increased risk of mortality from all causes and cancer. The association between waiting time and both all-cause and cause-specific mortality illustrated a pronounced J-shaped pattern. The prolong delay in treatment initiation significantly impacts the OS and CSS outcomes for non-surgical EC patients. Timely administration of treatment has the potential to enhance survival outcomes in patients with EC who are ineligible for surgery, including those in advanced stages without surgical options available.
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Affiliation(s)
- Yindi Sun
- Oncology Department, Zibo Central Hospital, Zibo, China
| | - Pei Zhang
- Oncology Department, Zibo Central Hospital, Zibo, China
| | - Dongqian Zhang
- The Sixth Department of Oncology, The Fourth People’s Hospital of Zibo, Zibo, China
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98
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Yoon KW, Yoo K, Choi K, Gil E, Park CM, Lee D. The implementation of the acute care surgery model in the management of patients with acute appendicitis - A 5-year single-center, retrospective experience: An observational study. Medicine (Baltimore) 2024; 103:e38927. [PMID: 39029014 DOI: 10.1097/md.0000000000038927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
We conducted this study to assess the effects of the acute care surgery (ACS) model in the management of patients with acute appendicitis (AA) based on our 5-year single-center, retrospective experience. The current single-center, retrospective, observational study was conducted in a consecutive series of the patients with AA who had been surgically treated at a tertiary referral hospital in Seoul, Korea, between January 2016 and December 2020. At our institution, the ACS model was first introduced in March 2018. Therefore, our clinical series of the patients were divided into 2 groups: the pre-ACS group (March 2014 to February 2018) and the post-ACS group (March 2018 to December 2022). Key time intervals include emergency department registration to request for surgical consultation, request for surgical consultation to decision on surgery, decision-to-operating room, time to decision on surgery and length of emergency department stay. Moreover, outcomes include rates of perforation and complications and discharge within 24 or 48 hours. We compared key time intervals, outcomes, and length of hospital stay between the 2 groups. A total of 900 patients with AA were finally included in the current study, 447 and 453 of whom were divided into the pre-ACS group (n = 447) and the post-ACS group (n = 453), respectively. There were significant differences in key time intervals, outcomes, and length of hospital stay between the 2 groups (P < .05). In conclusion, our results showed that the implementation of the ACS model was effective in improving key time intervals, rates of perforation, and discharge within 24 or 48 hours in the patients with AA.
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Affiliation(s)
- Kyoung Won Yoon
- Division of Critical Care, Department of Surgery, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
| | - Keesang Yoo
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoungjin Choi
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eunmi Gil
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chi-Min Park
- Division of Acute Care Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Donghyoun Lee
- Department of Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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99
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Zhou Y, Zhang S, Chen Z, Zhang X, Feng Y, Xu R. The association between serum phosphate and length of hospital stay and all-cause mortality in adult patients: a cross-sectional study. Nutr J 2024; 23:81. [PMID: 39026252 PMCID: PMC11256428 DOI: 10.1186/s12937-024-00982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/08/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Data is limited on the prevalence of hypophosphatemia in general hospitalized patients, and its association with length of hospital stay (LOS) and mortality remained unclear. We aimed to investigate the prevalence of admission phosphate abnormality and the association between serum phosphate level and length of hospital stay and all-cause mortality in adult patients. METHODS This was a multi-center retrospective study based on real-world data. Participants were classified into five groups according to serum phosphate level (inorganic phosphorus, iP) within 48 h after admission: G1, iP < 0.64 mmol/L; G2, iP 0.64-0.8 mmol/L; G3, iP 0.8-1.16 mmol/L; G4, iP 1.16-1.45 mmol/L; and G5, iP ≥ 1.45 mmol/L, respectively. Both LOS and in-hospital mortality were considered as outcomes. Clinical information, including age, sex, primary diagnosis, co-morbidity, and phosphate-metabolism related parameters, were also abstracted from medical records. RESULTS A total number of 23,479 adult patients (14,073 males and 9,406 females, aged 57.7 ± 16.8 y) were included in the study. The prevalence of hypophosphatemia was 4.74%. An "L-shaped" non-linear association was determined between serum phosphate level and LOS and the inflection point was 1.16 mmol/L in serum phosphate level. Compared with patients in G4, patients in G1, G2 or G3 were significantly associated with longer LOS after full adjustment of covariates. Each 0.1 mmol/L decrease in serum phosphate level to the left side of the inflection point led to 0.64 days increase in LOS [95% confidence interval (CI): 0.46, 0.81; p for trend < 0.001]. But there was no association between serum phosphate and LOS where serum levels of phosphate ≥ 1.16 mmol/L. Multivariable logistic regression analysis showed that adjusted all-cause in-hospital mortality was 3.08-fold greater in patients in G1 than those in G4 (95% CI: 1.52, 6.25; p for trend = 0.001). Similarly, no significant association with either LOS or mortality were found in patients in G5, comparing with G4. CONCLUSIONS Hypophosphatemia, but not hyperphosphatemia, was associated with LOS and all-cause mortality in adult inpatients. It is meaningful to monitor serum levels of phosphate to facilitate early diagnosis and intervention.
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Affiliation(s)
- Yiquan Zhou
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Shuyi Zhang
- Intensive Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Zhiqi Chen
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xiaomin Zhang
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yi Feng
- Department of Clinical Nutrition Center, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Renying Xu
- Department of Clinical Nutrition, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Department of Nutrition, College of Health Science and Technology, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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100
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Tirca L, Savin C, Stroescu C, Balescu I, Petrea S, Diaconu C, Gaspar B, Pop L, Varlas V, Hasegan A, Martac C, Bolca C, Stoian M, Zgura A, Gorecki GP, Bacalbasa N. Risk Factors and Prognostic Factors in GBC. J Clin Med 2024; 13:4201. [PMID: 39064241 PMCID: PMC11278318 DOI: 10.3390/jcm13144201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/05/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Gallbladder cancer (GBC) is a rare entity with a poor prognosis, usually discovered late due to nonspecific symptoms; therefore, over the last years, attention has been focused on identifying the risk factors for developing this malignancy in order to provide an early diagnosis, as well as new prognostic factors in order to modulate the long-term evolution of such cases. The aim of this review is to discuss both major risk factors and prognostic factors in GBC for a better understanding and integration of relevant and currently available information. Methods: A literature search was performed using Cochrane Library, PubMed, Google Scholar, Elsevier, and Web of Science; studies published after the year of 2000, in English, were reviewed. Results: Over time, risk factors associated with the development of GBC have been identified, which outline the profile of patients with this disease. The most important prognostic factors in GBC remain TNM staging, safety margin, and R0 status, along with perineural invasion and lymphovascular invasion. Both the technique and experience of the surgeons and a pathological examination that ensures final staging are particularly important and increase the chances of survival of the patients. Conclusions: improvements in surgical techniques and pathological analyses might provide better and more consistent guidance for medical staff in the management of patients with GBC.
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Affiliation(s)
- Luiza Tirca
- Department of Visceral Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.T.); (C.S.)
| | - Catalin Savin
- Department of Visceral Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.T.); (C.S.)
| | - Cezar Stroescu
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (S.P.); (B.G.); (N.B.)
- Department of Visceral Surgery, Center of Excellence in Translational Medicine, “Fundeni” Clinical Institute, 022336 Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.T.); (C.S.)
| | - Sorin Petrea
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (S.P.); (B.G.); (N.B.)
- Department of Surgery, “Ion Cantacuzino” Clinical Hospital, 020026 Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, “Floreasca” Clinical Emergency Hospital, 014453 Bucharest, Romania;
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Bogdan Gaspar
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (S.P.); (B.G.); (N.B.)
- Department of Visceral Surgery, “Floreasca” Clinical Emergency Hospital, 014453 Bucharest, Romania
| | - Lucian Pop
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.P.); (V.V.)
- Department of Obstetrics and Gynecology, National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania
| | - Valentin Varlas
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (L.P.); (V.V.)
- Department of Obstetrics and Gynecology, “Filantropia” Clinical Hospital, 011132 Bucharest, Romania
| | - Adrian Hasegan
- Department of Urology, Sibiu Emergency Hospital, Faculty of Medicine, University of Sibiu, 550024 Sibiu, Romania;
| | - Cristina Martac
- Department of Anesthesiology, Fundeni Clinical Hospital, 022336 Bucharest, Romania;
| | - Ciprian Bolca
- Department of Thoracic Surgery, ‘Marius Nasta’ National Institute of Pneumology, 050159 Bucharest, Romania;
- Department of Thoracic Surgery, Faculty of Medicine and Health Sciences, Sherbrooke University, Sherbrooke, QC J1K 2R1, Canada
- Department of Thoracic Surgery, ‘Charles LeMoyne’ Hospital, Longueuil, QC J4K 0A8, Canada
| | - Marilena Stoian
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine and Nephrology, Dr Ion Cantacuzino Hospital, 011438 Bucharest, Romania
| | - Anca Zgura
- Department of Medical Oncology, Oncological Institute Prof.Dr.Al.Trestioreanu, 022328 Bucharest, Romania;
- Department of Medical Oncology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Gabriel Petre Gorecki
- Department of Anesthesia and Intensive Care, CF 2 Clinical Hospital, 014256 Bucharest, Romania;
- Department of Anesthesia and Intensive Care, Faculty of Medicine, Titu Maiorescu University, 021251 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (S.P.); (B.G.); (N.B.)
- Department of Visceral Surgery, Center of Excellence in Translational Medicine, “Fundeni” Clinical Institute, 022336 Bucharest, Romania
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