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Mokbel K, Kodresko A, Ghazal H, Mokbel R, Trembley J, Jouhara H. Cryogenic Media in Biomedical Applications: Current Advances, Challenges, and Future Perspectives. In Vivo 2024; 38:1-39. [PMID: 38148045 PMCID: PMC10756490 DOI: 10.21873/invivo.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 12/28/2023]
Abstract
This paper explores the crucial role of cryogenic mediums in driving breakthroughs within the biomedical sector. The objective was to investigate, critically discuss, and present the current knowledge and state-of-the-art practices, along with the challenges and perspectives of the most common applications. Through an extensive literature review, this work aims to supplement existing research, offering a comprehensive and up-to-date understanding of the subject. Biomedical research involving cryogenic mediums is advancing on multiple fronts, including the development of advanced medical technologies, clinical treatments for life-threatening conditions, high-quality biospecimen preservation, and antimicrobial interventions in industrial food processing. These advances open new horizons and present cutting-edge opportunities for research and the medical community. While the current body of evidence showcases the impressive impact of cryogenic mediums, such as nitrogen, helium, argon, and oxygen, on revolutionary developments, reaching definitive conclusions on their efficiency and safety remains challenging due to process complexity and research scarcity with a moderate certainty of evidence. Knowledge gaps further underline the need for additional studies to facilitate cryogenic research in developing innovative technological processes in biomedicine. These advancements have the potential to reshape the modern world and significantly enhance the quality of life for people worldwide.
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Affiliation(s)
- Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London, U.K
| | - Alevtina Kodresko
- Heat Pipe and Thermal Management Research Group, College of Engineering, Design and Physical Sciences, Brunel University, London, U.K
| | - Heba Ghazal
- Kingston University, School of Pharmacy and Chemistry, Kingston Upon Thames, U.K
| | - Ramia Mokbel
- The Princess Grace Hospital, part of HCA Healthcare UK, London, U.K
| | - Jon Trembley
- Air Products PLC, Hersham Place Technology Park, Surrey, U.K
| | - Hussam Jouhara
- Heat Pipe and Thermal Management Research Group, College of Engineering, Design and Physical Sciences, Brunel University, London, U.K.;
- Vytautas Magnus University, Kaunas, Lithuania
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Qu Y, Qin S, Yang Z, Li Z, Liang Q, Long T, Wang W, Zeng D, Zhao Q, Dai Z, Ni Q, Zhao F, Kim W, Hou J. Targeting the DNA repair pathway for breast cancer therapy: Beyond the molecular subtypes. Biomed Pharmacother 2023; 169:115877. [PMID: 37951025 DOI: 10.1016/j.biopha.2023.115877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023] Open
Abstract
DNA repair is a vital mechanism in cells that protects against DNA damage caused by internal and external factors. It involves a network of signaling pathways that monitor and transmit damage signals, activating various cellular activities to repair DNA damage and maintain genomic integrity. Dysfunctions in this repair pathway are strongly associated with the development and progression of cancer. However, they also present an opportunity for targeted therapy in breast cancer. Extensive research has focused on developing inhibitors that play a crucial role in the signaling pathway of DNA repair, particularly due to the remarkable success of PARP1 inhibitors (PARPis) in treating breast cancer patients with BRCA1/2 mutations. In this review, we summarize the current research progress and clinical implementation of BRCA and BRCAness in targeted treatments for the DNA repair pathway. Additionally, we present advancements in diverse inhibitors of DNA repair, both as individual and combined approaches, for treating breast cancer. We also discuss the clinical application of DNA repair-targeted therapy for breast cancer, including the rationale, indications, and summarized clinical data for patients with different breast cancer subtypes. We assess their influence on cancer progression, survival rates, and major adverse reactions. Last, we anticipate forthcoming advancements in targeted therapy for cancer treatment and emphasize prospective areas of development.
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Affiliation(s)
- Yuting Qu
- Zunyi Medical University, No.6 Xuefu West Road, Zunyi, Guizhou Province, 563006, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Sisi Qin
- Department of Integrated Biomedical Science, Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan, 31151 Chungcheongnam-do, Republic of Korea
| | - Zhihui Yang
- Zunyi Medical University, No.6 Xuefu West Road, Zunyi, Guizhou Province, 563006, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Zhuolin Li
- GuiZhou University Medical College, Guiyang, Guizhou Province 550025, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Qinhao Liang
- Zunyi Medical University, No.6 Xuefu West Road, Zunyi, Guizhou Province, 563006, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Ting Long
- Guizhou Medical University, NO.9 Beijing Road, Guiyang, Guizhou Province 550004, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Weiyun Wang
- Guizhou University of Traditional Chinese Medicine, NO.50 Shi Dong Road, Guiyang, Guizhou Province 550002, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Dan Zeng
- Guizhou Medical University, NO.9 Beijing Road, Guiyang, Guizhou Province 550004, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Qing Zhao
- Guizhou Medical University, NO.9 Beijing Road, Guiyang, Guizhou Province 550004, China; Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Zehua Dai
- Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Qing Ni
- Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China
| | - Fei Zhao
- College of Biology, Hunan University, Changsha 410082, China
| | - Wootae Kim
- Department of Integrated Biomedical Science, Soonchunhyang Institute of Medi-bio Science (SIMS), Soonchunhyang University, Cheonan, 31151 Chungcheongnam-do, Republic of Korea.
| | - Jing Hou
- Department of Breast Surgery, Guizhou Provincial People's Hospital, NO.83 Zhongshan East Road, Guiyang, Guizhou Province 550002, China.
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Eğlenen MN, Yavan MA. Has the COVID-19 Pandemic Affected Orthodontists' Interest in Various Orthodontic Appliances? Turk J Orthod 2023; 36:216-223. [PMID: 38164005 PMCID: PMC10763601 DOI: 10.4274/turkjorthod.2023.2022.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/03/2023] [Indexed: 01/03/2024]
Abstract
Objective To determine the changes in orthodontists' interest in various orthodontic appliances during the coronavirus disease-2019 (COVID-19) pandemic. Methods A questionnaire probing respondents' interest in orthodontic appliances and techniques, including standard buccal metal brackets, self-ligating brackets, standard ceramic brackets, lingual brackets, clear aligners, orthodontic facemasks, removable functional appliances, fixed functional appliances, orthognathic surgery, orthodontic miniscrews, and lingual retainers, was prepared using Google Forms and then sent to the Turkish Orthodontic Society to invite all members of the society to participate in the survey. Of the 1903 members invited, 230 (response rate, 12.08%) orthodontists completed the questionnaire. Results The respondents' interest in brackets did not change among 70% of the respondents (standard buccal metal bracket 80%, self-ligating bracket 72.2%, standard ceramic bracket 77%, and lingual bracket 76.5%). A significant difference was observed between the genders only about the interest in standard metal brackets and fixed functional appliances (p<0.05 for both). Interest in standard metal brackets decreased as respondents' work experience increased (p<0.05). The interest in self-ligating brackets was higher among respondents with 1-5 years of experience than among other respondents (p<0.05). Interest in self-ligating brackets increased more among lecturers and residents than among clinicians (p<0.05). Conclusion The interest of orthodontists in clear aligners showed the highest increase during the COVID-19 pandemic among all orthodontic appliances, whereas their interest in other appliances, particularly standard buccal metal brackets, did not change.
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Affiliation(s)
- Merve Nur Eğlenen
- Yeditepe University Faculty of Dentistry, Department of Orthodontics, İstanbul, Turkey
| | - Mehmet Ali Yavan
- Adıyaman University Faculty of Dentistry, Department of Orthodontics, Adıyaman, Turkey
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Chang CL, Lin KC, Chen WM, Shia BC, Wu SY. Comparative Effectiveness of Intensity-Modulated Proton Therapy Versus Intensity-Modulated Radiotherapy for Patients With Inoperable Esophageal Squamous Cell Carcinoma Undergoing Curative-Intent Concurrent Chemoradiotherapy. J Thorac Oncol 2023:S1556-0864(23)02430-9. [PMID: 38154513 DOI: 10.1016/j.jtho.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION This study compared outcomes in patients with inoperable esophageal squamous cell carcinoma (ESCC) undergoing curative-intent concurrent chemoradiotherapy (CCRT) with intensity-modulated radiotherapy (IMRT) versus intensity-modulated proton therapy (IMPT). METHODS The study encompassed a retrospective cohort analysis of patients with inoperable ESCC who underwent curative-intent CCRT from January 1, 2015, to December 31, 2020, with data sourced from the Taiwan Cancer Registry Database. In this study, both IMRT and IMPT delivered a total equivalent effective dose of approximately 5040 cGy in 28 fractions, accompanied by platinum-based chemotherapy administered as per established protocols. Multivariate Cox regression analyses were performed to assess oncologic outcomes, and statistical analyses were conducted, including inverse probability of treatment-weighted and Fine and Gray method for competing risks. RESULTS The observed risks of ESCC-specific and all-cause mortality were lower in patients treated with IMPT compared with those treated with IMRT, with adjusted hazard ratios (aHRs) of 0.62 (95% confidence interval [CI]: 0.58-0.70) and 0.72 (95% CI: 0.66-0.80), respectively. IMPT also reduced grade 2 radiation-induced side effects, such as pneumonitis, fatigue, and major adverse cardiovascular events, with aHRs (95% CI) of 0.76 (0.66-0.82), 0.10 (0.07-0.14), and 0.70 (0.67-0.73), respectively. However, IMPT was associated with an increased risk of grade 2 radiation dermatitis, with aHR (95% CI) of 1.48 (1.36-1.60). No substantial differences were found in the incidence of radiation esophagitis between IMPT and IMRT when adjusting for covariates. CONCLUSION IMPT seems to be associated with superiority over IMRT in managing patients with inoperable ESCC undergoing curative-intent CCRT, suggesting improved survival outcomes and reduced toxicity. These findings have significant implications for the treatment of ESCC, particularly when surgery is not an option.
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Affiliation(s)
- Chia-Lun Chang
- Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Chou Lin
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wan-Ming Chen
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan; Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan; Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan; Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan; Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan; Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Management, College of Management, Fo Guang University, Yilan, Taiwan.
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155
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Cao L, Liu X, Sun T, Zhang Y, Bao T, Cheng H, Tian Z. Predictive and Diagnostic Values of Systemic Inflammatory Indices in Bronchopulmonary Dysplasia. Children (Basel) 2023; 11:24. [PMID: 38255338 PMCID: PMC10814477 DOI: 10.3390/children11010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Bronchopulmonary dysplasia (BPD) is the most common respiratory complication in preterm infants, and there is a lag in the diagnosis of BPD. Inflammation is a vital pathogenic factor for BPD; we aim to evaluate the predictive and diagnostic values of systemic inflammatory indices in BPD. METHODS Between 1 January 2019 and 31 May 2023, the clinical data of 122 premature infants with a gestational age of <32 weeks in the Department of Neonatology, the Affiliated Huai'an No. 1 People's Hospital of Nanjing Medical University, were retrospectively collected and classified into non-BPD (n = 72) and BPD (n = 50) groups based on the National Institute of Child Health and Human Development 2018 criteria. To compare the general characteristics of each group, we identified the independent risk variables for BPD using multivariate logistic regression analysis, compared the systemic inflammatory indices at birth, 72 h, 1 week, 2 weeks, and 36 weeks postmenstrual age (PMA), and constructed the receiver operating characteristic curves of neutrophil-to-lymphocyte ratio (NLR) diagnosis of BPD at different time points. RESULTS ① The independent risk factors for BPD in preterm infants were birth weight, small for gestational age, and days of oxygen therapy (all p < 0.05). ② At 72 h and 1 week after birth, the serum NLR of the BPD group was higher than for the non-BPD group (p < 0.05). Furthermore, the neutrophil count (N), NLR, monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index, systemic inflammation response index (SIRI), and pan-immune-inflammation value of infants with BPD were higher than the non-BPD group at 3 weeks after birth (p < 0.05). Moreover, at 36 weeks of PMA, the serum N, NLR, MLR, and SIRI of BPD infants were higher than those of non-BPD infants (p < 0.05). ③ The NLR of infants with and without BPD gradually increased after birth, reaching a peak at 72 h and 1 week, respectively. At 3 weeks postnatal, the NLR had the highest predictive power for BPD, with an area under the curve (AUC) of 0.717 (p < 0.001); the sensitivity was 56% and specificity was 86.1%. In addition, the NLR at 36 weeks of PMA exhibited some diagnostic value for BPD. The AUC was 0.693 (p < 0.001), the sensitivity was 54%, and specificity was 83.3%. CONCLUSIONS At 3 weeks after birth and 36 weeks of PMA, some systemic inflammation indices (like N, NLR, SIRI) of preterm infants with BPD have specific predictive and diagnostic values; these indices may help the management of high-risk preterm infants with BPD.
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Affiliation(s)
| | | | | | | | | | | | - Zhaofang Tian
- Department of Neonatology, The Affiliated Huaian No.1 People’s Hospital of Nanjing Medical University, Huai’an 223300, China; (L.C.); (X.L.); (T.S.); (Y.Z.); (T.B.); (H.C.)
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156
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Geropoulos G, Moschonas S, Fanariotis G, Koltsida A, Madouros N, Koumadoraki E, Katsikas Triantafyllidis K, Kechagias KS, Koimtzis G, Giannis D, Notopoulos A, Pavlidis ET, Psarras K. Anastomotic Leak and Perioperative Outcomes of Esophagectomy for Esophageal Cancer during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Medicina (Kaunas) 2023; 60:31. [PMID: 38256292 PMCID: PMC10818348 DOI: 10.3390/medicina60010031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The coronavirus disease-2019 (COVID-19) pandemic influenced the healthcare system tremendously, as well as the number of elective surgical procedures worldwide. The aim of this study is to investigate the COVID-19 pandemic's impact on esophagectomies. Materials and Methods: The MEDLINE (via PubMed), Cochrane Library, and Google Scholar bibliographical databases were systematically searched. Original clinical studies investigating the outcomes of esophageal cancer surgery during the COVID-19 pandemic were deemed eligible. After exclusion criteria were applied, eight studies were considered eligible for inclusion. Results: Eight studies with non-overlapping populations, reporting on patients undergoing esophagectomy for resectable esophageal cancer during the COVID-19 pandemic, were included in our analysis, with a total of 18548 patients. Background characteristics for age, lung disease, smoking history as well as Body Mass Index and age were equal among the groups. The background of diabetes presented a statistically significant difference among the groups. Perioperative outcomes like reoperation rates, the length of intensive care unit stay, or readmission rates were not significantly increased during the pandemic. The 30-day readmission, and 30- and 90-day mortality were not affected either. The length of hospital stay was significantly lower in the non-pandemic period. Conclusions: The results of our study support the evidence that in the context of the COVID-19 pandemic, esophageal cancer operations took place safely and effectively, similarly to the standards of the non-COVID-19 era.
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Affiliation(s)
- Georgios Geropoulos
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Stavros Moschonas
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Georgios Fanariotis
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Aggeliki Koltsida
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Nikolaos Madouros
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | - Evgenia Koumadoraki
- Surgery Working Group, Society of Junior Doctors, 15123 Athens, Greece; (S.M.); (A.K.); (E.K.)
| | | | - Konstantinos S. Kechagias
- Department of Obstetrics and Gynaecology, The Hillingdon Hospitals NHS Foundation Trust, Uxbridge UB8 3NN, UK
| | - Georgios Koimtzis
- Department of General Surgery, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Dimitrios Giannis
- Department of Surgery, Flushing Hospital Medical Center, Flushing, NY 11355, USA;
| | - Athanasios Notopoulos
- Department of Nuclear Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Efstathios T. Pavlidis
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Kyriakos Psarras
- Second Surgical Propedeutic Department, Hippocration Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Yamamoto C, Nukui Y, Furukawa K, Taniguchi M, Yamano T, Inaba T, Kikai R, Tanino Y, Yamada Y, Teramukai S, Takayama K. SARS-CoV-2 RT-PCR as a universal screening on planned admission in asymptomatic patients. J Infect Chemother 2023:S1341-321X(23)00314-8. [PMID: 38135218 DOI: 10.1016/j.jiac.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 11/13/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
Universal screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on admission is reportedly beneficial in preventing nosocomial infections. However, some issues remain, including low positivity rate, cost, and time required for testing. We describe SARS-CoV-2 reverse transcription polymerase chain reaction (PCR) for universal screening in asymptomatic patients on planned admissions. In total, 14,574 patients were included between October 12, 2020, and June 23, 2022. The PCR-positive rate for the period was 0.44 % (64/14,574). The PCR positivity for the epidemic period by strain was 0.28 % (95 % confidence interval [CI] 0.12-0.56 %), 0.16 % (95 % CI 0.05-0.37 %), 0.21 % (95 % CI 0.09-0.41 %), and 0.9 % (95 % CI 0.65-1.2 %) for the wild-type strain, Alpha, Delta, and Omicron variants, respectively. The proportion of Ct values < 30 was higher in the first half of the epidemic (first vs. second, 29.4 % [95 % CI 16.9-44.8 %] vs. 16.7 % [95 % CI 6.0-28.5 %]), whereas that of Ct values ≥ 35 increased significantly in the second half (first vs. second, 32.4 % [95 % CI 19.3-47.8 %] vs. 70.0 % [95 % CI 53.5-83.4 %]). Of all positives, 50 % (32/64) had a coronavirus disease (COVID-19) history before PCR screening, with a median of 28 days (10-105) from COVID-19 onset or positive to PCR screening. PCR screening may help detect positives with high viral loads early in the epidemic for each mutant strain, with an increasing proportion of positives with low viral loads later in the epidemic. PCR testing may be unnecessary for recently diagnosed cases and patients in whom reinfection is unlikely.
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Affiliation(s)
- Chie Yamamoto
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Yoko Nukui
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keitaro Furukawa
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Tetsuhiro Yamano
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tohru Inaba
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Rie Kikai
- Department of Clinical Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoko Tanino
- Department of Clinical Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yukiji Yamada
- Department of Clinical Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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158
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Hayden MK, Hanson KE, Englund JA, Lee MJ, Loeb M, Lee F, Morgan DJ, Patel R, El Mikati IK, Iqneibi S, Alabed F, Amarin JZ, Mansour R, Patel P, Falck-Ytter Y, Morgan RL, Murad MH, Sultan S, Bhimraj A, Mustafa RA. The Infectious Diseases Society of America Guidelines on the Diagnosis of Coronavirus Disease 2019 (COVID-19): Molecular Diagnostic Testing. Clin Infect Dis 2023:ciad646. [PMID: 38112284 DOI: 10.1093/cid/ciad646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Indexed: 12/21/2023] Open
Abstract
Accurate molecular diagnostic tests are necessary for confirming a diagnosis of coronavirus disease 2019 (COVID-19) and for identifying asymptomatic carriage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of available SARS-CoV-2 nucleic acid detection tests continues to increase as does the COVID-19 diagnostic literature. Thus, the Infectious Diseases Society of America (IDSA) developed an evidence-based diagnostic guideline to assist clinicians, clinical laboratorians, patients, and policymakers in decisions related to the optimal use of SARS-CoV-2 nucleic acid amplification tests. In addition, we provide a conceptual framework for understanding molecular diagnostic test performance, discuss nuances of test result interpretation in a variety of practice settings, and highlight important unmet research needs related to COVID-19 diagnostic testing. IDSA convened a multidisciplinary panel of infectious diseases clinicians, clinical microbiologists, and experts in systematic literature review to identify and prioritize clinical questions and outcomes related to the use of SARS-CoV-2 molecular diagnostics. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make testing recommendations. The panel agreed on 12 diagnostic recommendations. Access to accurate SARS-CoV-2 nucleic acid testing is critical for patient care, hospital infection prevention, and the public health response to COVID-19 infection. Information on the clinical performance of available tests continues to grow, but the quality of evidence of the current literature to support this updated molecular diagnostic guideline remains moderate to very low. Recognizing these limitations, the IDSA panel weighed available diagnostic evidence and recommends nucleic acid testing for all symptomatic individuals suspected of having COVID-19. In addition, testing is suggested for asymptomatic individuals with known or suspected contact with a COVID-19 case when the results will impact isolation/quarantine/personal protective equipment (PPE) usage decisions. Evidence in support of rapid testing and testing of upper respiratory specimens other than nasopharyngeal swabs, which offer logistical advantages, is sufficient to warrant conditional recommendations in favor of these approaches.
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Affiliation(s)
- Mary K Hayden
- Division of Infectious Diseases, Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Kimberly E Hanson
- Divisions of Infectious Diseases and Clinical Microbiology, University of Utah, Salt Lake City, Utah, USA
| | - Janet A Englund
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Mark J Lee
- Department of Pathology and Clinical Microbiology Laboratory, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark Loeb
- Division of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Francesca Lee
- Departments of Pathology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robin Patel
- Division of Clinical Microbiology and Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ibrahim K El Mikati
- Outcomes and Implementation Research Unit, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shahad Iqneibi
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Farouk Alabed
- School of Medicine, The University of Kansas, Kansas City, Kansas, USA
| | - Justin Z Amarin
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Razan Mansour
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Payal Patel
- Department of Pulmonary, Allergy, Critical Care, and Sleep Medicine and Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Yngve Falck-Ytter
- Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - M Hassan Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
| | - Adarsh Bhimraj
- Houston Methodist Hospital, Center of Excellence for Infectious Diseases, Houston Methodist Research Institute, Houston, Texas, USA
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
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159
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Nappi F. To Gain Insights into the Pathophysiological Mechanisms of the Thrombo-Inflammatory Process in the Atherosclerotic Plaque. Int J Mol Sci 2023; 25:47. [PMID: 38203218 PMCID: PMC10778759 DOI: 10.3390/ijms25010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/17/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
Thromboinflammation, the interplay between thrombosis and inflammation, is a significant pathway that drives cardiovascular and autoimmune diseases, as well as COVID-19. SARS-CoV-2 causes inflammation and blood clotting issues. Innate immune cells have emerged as key modulators of this process. Neutrophils, the most predominant white blood cells in humans, are strategically positioned to promote thromboinflammation. By releasing decondensed chromatin structures called neutrophil extracellular traps (NETs), neutrophils can initiate an organised cell death pathway. These structures are adorned with histones, cytoplasmic and granular proteins, and have cytotoxic, immunogenic, and prothrombotic effects that can hasten disease progression. Protein arginine deiminase 4 (PAD4) catalyses the citrullination of histones and is involved in the release of extracellular DNA (NETosis). The neutrophil inflammasome is also required for this process. Understanding the link between the immunological function of neutrophils and the procoagulant and proinflammatory activities of monocytes and platelets is important in understanding thromboinflammation. This text discusses how vascular blockages occur in thromboinflammation due to the interaction between neutrophil extracellular traps and ultra-large VWF (von Willebrand Factor). The activity of PAD4 is important for understanding the processes that drive thromboinflammation by linking the immunological function of neutrophils with the procoagulant and proinflammatory activities of monocytes and platelets. This article reviews how vaso-occlusive events in thrombo-inflammation occur through the interaction of neutrophil extracellular traps with von Willebrand factor. It highlights the relevance of PAD4 in neutrophil inflammasome assembly and neutrophil extracellular traps in thrombo-inflammatory diseases such as atherosclerosis and cardiovascular disease. Interaction between platelets, VWF, NETs and inflammasomes is critical for the progression of thromboinflammation in several diseases and was recently shown to be active in COVID-19.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
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160
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Ludwig-Walz H, Siemens W, Heinisch S, Dannheim I, Loss J, Bujard M. How the COVID-19 pandemic and related school closures reduce physical activity among children and adolescents in the WHO European Region: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2023; 20:149. [PMID: 38115056 PMCID: PMC10731871 DOI: 10.1186/s12966-023-01542-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. However, a differentiated overview of European youth is lacking. In particular, no systematic analysis has been conducted to date on the impact of heterogeneous pandemic restrictions and school closures within European countries, and with regard to potentially vulnerable groups. METHODS We searched seven databases and included studies for children and adolescents (≤ 19 years) of the WHO European Region that compared physical activity during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index and School Closure Index as indicators of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using the 'Risk of Bias in Non-randomized Studies - of Exposure' [ROBINS-E]) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Unpublished data was requested from study authors. Data were pooled in random effects models. An a priori protocol was published, reporting is carried out in accordance with the 'Preferred Reporting Items for Systematic Review and Meta-Analyses' (PRISMA) statement. RESULTS Of 14,897 non-duplicate records, 26 publications (n = 15,038 pre-pandemic, n = 13,041 during pandemic) met full inclusion criteria. Comparison before and during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95%CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 min per day (a 20% reduction of the WHO recommendation). A decrease in sporting activity was also recorded. Subgroup analyses suggested that middle childhood (aged 8-12) and adolescents were particularly affected by the decline. School closures were associated with a reduction in physical activity. The certainty of evidence for all outcomes was low. CONCLUSIONS A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic. This decline was higher during periods of school closure and mainly affected younger schoolchildren and adolescents. Immediate action by policy-makers and practitioners, as well as evidence-based public health strategies, are imperative in reversing this trend. TRIAL REGISTRATION PROSPERO: CRD42023395871.
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Affiliation(s)
| | - Waldemar Siemens
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Sarah Heinisch
- Institute for Physical Education and Sport, University of Education, Karlsruhe, Germany
| | - Indra Dannheim
- Regional Innovation Center for Health and Quality of Life in Fulda (RIGL), Fulda University of Applied Sciences, Fulda, Germany
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany
| | | | - Martin Bujard
- Federal Institute for Population Research (BiB), Wiesbaden, Germany
- Institute of Medical Psychology, Medical Faculty, University Heidelberg, Heidelberg, Germany
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161
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Kempf E, Priou S, Lamé G, Laurent A, Guével E, Tzedakis S, Bey R, Fuks D, Chatellier G, Tannier X, Galula G, Flicoteaux R, Daniel C, Tournigand C. No changes in clinical presentation, treatment strategies and survival of pancreatic cancer cases during the SARS-COV-2 outbreak: A retrospective multicenter cohort study on real-world data. Int J Cancer 2023; 153:1988-1996. [PMID: 37539961 DOI: 10.1002/ijc.34675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Abstract
The SARS-COV-2 pandemic disrupted healthcare systems. We assessed its impact on the presentation, care trajectories and outcomes of new pancreatic cancers (PCs) in the Paris area. We performed a retrospective multicenter cohort study on the data warehouse of Greater Paris University Hospitals (AP-HP). We identified all patients newly referred with a PC between January 1, 2019, and June 30, 2021, and excluded endocrine tumors. Using claims data and health records, we analyzed the timeline of care trajectories, the initial tumor stage, the treatment categories: pancreatectomy, exclusive systemic therapy or exclusive best supportive care (BSC). We calculated patients' 1-year overall survival (OS) and compared indicators in 2019 and 2020 to 2021. We included 2335 patients. Referral fell by 29% during the first lockdown. The median time from biopsy and from first MDM to treatment were 25 days (16-50) and 21 days (11-40), respectively. Between 2019 and 2020 to 2021, the rate of metastatic tumors (36% vs 33%, P = .39), the pTNM distribution of the 464 cases with upfront tumor resection (P = .80), and the proportion of treatment categories did not vary: tumor resection (32% vs 33%), exclusive systemic therapy (49% vs 49%), exclusive BSC (19% vs 19%). The 1-year OS rates in 2019 vs 2020 to 2021 were 92% vs 89% (aHR = 1.42; 95% CI, 0.82-2.48), 52% vs 56% (aHR = 0.88; 95% CI, 0.73-1.08), 13% vs 10% (aHR = 1.00; 95% CI, 0.78-1.25), in the treatment categories, respectively. Despite an initial decrease in the number of new PCs, we did not observe any stage shift. OS did not vary significantly.
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Affiliation(s)
- Emmanuelle Kempf
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), Université Sorbonne Paris Nord, Sorbonne Université, Inserm, Paris, France
- Department of Medical Oncology, Assistance Publique - Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Créteil, France
| | - Sonia Priou
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Guillaume Lamé
- Université Paris-Saclay, CentraleSupélec, Laboratoire Génie Industriel, Gif-sur-Yvette, France
| | - Alexis Laurent
- Department of Digestive Surgery, Assistance Publique - Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Créteil, France
| | - Etienne Guével
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Stylianos Tzedakis
- Department of Digestive Surgery, Assistance Publique - Hôpitaux de Paris, Cochin Teaching Hospital, Université Paris City, Paris, France
| | - Romain Bey
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
| | - David Fuks
- Department of Digestive Surgery, Assistance Publique - Hôpitaux de Paris, Cochin Teaching Hospital, Université Paris City, Paris, France
| | - Gilles Chatellier
- Department of Medical Informatics, Assistance Publique - Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
| | - Xavier Tannier
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé (LIMICS), Université Sorbonne Paris Nord, Sorbonne Université, Inserm, Paris, France
| | - Gilles Galula
- Department of Medical Oncology, Assistance Publique - Hôpitaux de Paris, Tenon Teaching Hospital, Université Sorbonne, Paris, France
| | - Rémi Flicoteaux
- Department of Medical Information, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Christel Daniel
- IT Department, Assistance Publique - Hôpitaux de Paris, Innovation and Data, Paris, France
| | - Christophe Tournigand
- Department of Medical Oncology, Assistance Publique - Hôpitaux de Paris, Henri Mondor and Albert Chenevier Teaching Hospital, Université Paris Est Créteil, Créteil, France
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162
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Del Chiaro M, Sugawara T, Karam SD, Messersmith WA. Advances in the management of pancreatic cancer. BMJ 2023; 383:e073995. [PMID: 38164628 DOI: 10.1136/bmj-2022-073995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Pancreatic cancer remains among the malignancies with the worst outcomes. Survival has been improving, but at a slower rate than other cancers. Multimodal treatment, including chemotherapy, surgical resection, and radiotherapy, has been under investigation for many years. Because of the anatomical characteristics of the pancreas, more emphasis on treatment selection has been placed on local extension into major vessels. Recently, the development of more effective treatment regimens has opened up new treatment strategies, but urgent research questions have also become apparent. This review outlines the current management of pancreatic cancer, and the recent advances in its treatment. The review discusses future treatment pathways aimed at integrating novel findings of translational and clinical research.
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Affiliation(s)
- Marco Del Chiaro
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
| | - Toshitaka Sugawara
- Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Sana D Karam
- University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Wells A Messersmith
- University of Colorado Cancer Center, University of Colorado School of Medicine, Aurora, CO, USA
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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163
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Sweed D, Mohamady M, Gouda MA, Fayed Y, Saied SA, Elhamed SMA. Does the expression of granzyme B participate in inflammation, fibrosis, and fertility of hydatid cysts? Parasitol Res 2023; 123:22. [PMID: 38072840 PMCID: PMC10710967 DOI: 10.1007/s00436-023-08056-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023]
Abstract
Echinococcus granulosus (sensu lato), a cestode that is endemic in Egypt, causes cystic echinococcosis (CE), a significant but neglected zoonotic disease that is prevalent throughout the world. Infected hydatid cysts are classified as fertile or non-fertile based on the presence of protoscoleces; nevertheless, the mechanism of non-fertile CE cysts remains unknown. The study aimed to assess whether granzyme B (GrB) expression and CD4 + /CD8 + could be related to the induction of non-fertile CE cysts. A total of fifty-eight individuals diagnosed with visceral hydatid cysts were selected, and they were further divided according to cyst fertility into fertile and non-fertile. Immunohistochemistry for CD4, CD8, and GrB was done. According to the results, hydatid cysts are common in adults and have no gender preference. The same clinical and laboratory data were shared by patients with fertile and non-fertile cysts (p = 0.186). GrB expression was not impacted by the fibrous deposition inside the hydatid cyst wall (p = 0.85); however, GrB was significantly correlated with the inflammatory density (p = 0.005). GrB expression was also found to be significantly higher in non-fertile cysts (p = 0.04). GrB expression is positively correlated with CD4 and CD8 expression. In conclusion, the expression of GrB in hydatid cysts may exacerbate the inflammatory response and impede cyst fertility while not affecting the fibrous deposition in the cyst wall.
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Affiliation(s)
- Dina Sweed
- Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt.
| | - Mohamed Mohamady
- Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt
| | - Marwa A Gouda
- Clinical and Molecular Parasitology Department, National Liver Institute, Shebin Elkom, Menoufia, Egypt
| | - Yahya Fayed
- Hepatopancreatobiliary Surgery Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt
| | - Sara A Saied
- Clinical Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt
| | - Sara M Abd Elhamed
- Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia, Egypt
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164
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Walters ET, Palackic A, Franco-Mesa C, Shah NR, Erickson MJ, Wolf SE. The impact of COVID-19 on clinical outcomes of burn patients. Burns Trauma 2023; 11:tkad042. [PMID: 38074193 PMCID: PMC10699731 DOI: 10.1093/burnst/tkad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 03/30/2023] [Accepted: 07/20/2023] [Indexed: 02/12/2024]
Abstract
Background Multiple studies have shown the SARS-CoV-2 virus (COVID-19) to be associated with deleterious outcomes in a wide range of patients. The impact of COVID-19 has not been well investigated among burned patients. We suspect that patients will have worsened respiratory and thrombotic complications, ultimately leading to increased mortality. The objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn injury. Methods This is a retrospective, propensity matched, cohort study. We examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020, to 31 July 2021, and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease, tenth revision (ICD-10) codes. Study participants included adults who were treated for a burn injury during the study period. Results We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection (total 1472 patients, mean age 36.3 ± 24.3). We found no significant increase in mortality observed for patients with concurrent COVID-19 (OR 1.203, 95% CI 0.517-2.803; p = 0.6675). We did observe significant increase in infections (OR 3.537, 95% CI 2.798-4.471; p = 0.0001), thrombotic complications (OR 2.342, 95% CI 1.351-4.058; p = 0.0018), as was the incidence of hypertrophic scarring (OR 3.368, 95% CI 2.326-4.877; p = 0.0001). Conclusions We observed that concurrent COVID-19 infection was associated with an increase in infections, thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.
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Affiliation(s)
- Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Camila Franco-Mesa
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Michael J Erickson
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University, Galveston, TX, USA
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165
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Taylor O, Boardman G, Bentel J, Laycock A. Discordance between clinical and pathologic staging and the timeliness of care of non-small cell lung cancer patients diagnosed with operable tumors. Asia Pac J Clin Oncol 2023; 19:706-714. [PMID: 36707405 DOI: 10.1111/ajco.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/02/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
AIM This study was performed to evaluate concordance between clinical and pathologic staging of non-small cell lung cancer (NSCLC) in our hospital network. METHODS We retrospectively reviewed records of 417 patients with NSCLC who received curative surgery and whose pathology was evaluated in our hospital between 2016 and 2021. Cytology, tissue pathology, and associated clinical, surgical, and imaging information were retrieved from hospital digital records. RESULTS The cohort included 214 female and 203 male patients aged 20.6-85.8 years. Median times among staging computed tomography and surgery (105 days [interquartile range (IQR) 77.0-143.0]), positron emission tomography and surgery (78.5 days [IQR 56.0-109.0]), and endobronchial ultrasound-guided transbronchial needle aspiration and surgery (59 days [IQR 42-94]) indicated that Australian guidelines of <42 days between original referral and commencement of treatment were not being met in the majority of cases. Discordance between clinical TNM (cTNM) and pathologic TNM staging was 25.9%, including 18.4% cases that were clinically understaged and two patients with undetected stage IVA disease. cTNM understaging was significantly associated with time between the final staging investigation and surgery (p = .023), pleural (p < .05) and vessel (p < .05) invasion, and diagnosis of high-grade adenocarcinoma (p = .001). CONCLUSION Discordance between clinical and pathologic staging of NSCLC is associated with tumor histopathologic characteristics and treatment delays. Although tumor factors that lead to discordant staging cannot be controlled, reduced time to surgery may have resulted in better outcomes for some patients in this potentially curable lung cancer cohort.
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Affiliation(s)
- Oliver Taylor
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Glenn Boardman
- Clinical Service Planning & Population Health, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jacqueline Bentel
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Andrew Laycock
- PathWest Anatomical Pathology, Fiona Stanley Hospital, Perth, Western Australia, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
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Fancellu A, Deiana G, Sanna V, Rubino C, Cossu A, Cottu P, Giuliani G, Sant L, Norcia G, Porcu A. Rising age-specific rates of immediate breast reconstruction after mastectomy: Report from an Italian Breast Unit. J Surg Oncol 2023; 128:1227-1234. [PMID: 37592864 DOI: 10.1002/jso.27420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Immediate breast reconstruction (IBR) represents a fundamental part in the management of patients receiving mastectomy. In recent years, there has been an increasing trend in the use of IBR in all age groups. The study aims were to evaluate the age-specific trend of IBR, and to discuss its effects in work organization at an Italian Breast Unit. METHODS We searched for women diagnosed with breast cancer between 2010 and 2019, focusing on IBR rates in patients who received mastectomy. Age-specific trends were assessed using the Cochrane-Armitage test. Differences in operative times and hospital stay between women undergoing mastectomy + IBR (Ma + IBR) or mastectomy alone (Ma) were evaluated by Student's t test or χ2 test. RESULTS Among 1915 patients, 62.4% underwent breast conserving surgery (BCS), and 37.6% mastectomy. Overall, rates of Ma + IBR increased from 32% in 2010 to 58% in 2019 (p < 0.001). Although rates of IBR rose in all age groups, the trend was significantly increased among patients aged 50-59 (p < 0.001), 60-69 (p < 0.0001), and 70-79 (p < 0.05). CONCLUSIONS Rates of Ma + IBR have increased over years, especially among older women. Ma + IBR resulted in longer operative times and hospital stay than Ma alone. These findings imply that, in the near future, resources should be implemented to improve and strengthen the surgical activity of Breast Units, to support the increasing use of IBR in women of all age groups.
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Affiliation(s)
- Alessandro Fancellu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giulia Deiana
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Valeria Sanna
- AOU Sassari, Department of Oncohematology, Unit of Medical Oncology, Sassari, Italy
| | - Corrado Rubino
- Department of Medicine, Surgery and Pharmacy, Unit of Plastic Surgery, University of Sassari, Sassari, Italy
| | - Antonio Cossu
- Department of Medicine, Surgery and Pharmacy, Unit of Pathology, University of Sassari, Sassari, Italy
| | - Pietrina Cottu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Giuliana Giuliani
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
| | - Lisa Sant
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Giuseppe Norcia
- Faculty of Medicine and Surgery, University of Sassari Medical School, Sassari, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2-Clinica Chirurgica, University of Sassari, Sassari, Italy
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Compagnoni R, Cucchi D, Klumpp R, Ronga M, Berruto M, Di Giacomo G, Randelli PS. Operational strategies to deal with the COVID-19 emergency: recommendations from the Italian national society SIAGASCOT following the introduction of vaccines against the SARS-CoV-2 infection. Musculoskelet Surg 2023; 107:471-479. [PMID: 37658981 PMCID: PMC10709259 DOI: 10.1007/s12306-023-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/20/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND This article aims to present the operational recommendations adopted by the Italian national society for orthopaedic surgery, arthroscopy, and sports medicine (SIAGASCOT) in managing patients eligible to undergo elective orthopaedic surgery during the COVID-19 pandemic after the beginning of a national vaccination campaign. MATERIALS AND METHODS An extensive literature search, analysing medical databases and scientific societies protocols, was performed to support this document. A four-step approach was used: 1-definition of priorities; 2-definition of significant clusters of interventions; 3-extraction of recommendations from international literature; and 4-adaptation of the recommendations to the specific features of the Italian healthcare system. RESULTS Three operational priorities were defined ("continuity of care and containment of the virus spread", "examination of waiting lists", and "definition of the role of vaccines"), six significant clusters of intervention were identified, and recommendations regarding the risk management for healthcare staff and hospital facility as well as the preoperative, in-hospital, and postoperative management were produced. Patient selection, preoperative screening, and pre-hospitalization procedures, which are regarded as pivotal roles in the safe management of patients eligible to undergo elective orthopaedic surgery, were analysed extensively. CONCLUSIONS This document presents national-wide recommendations for managing patients eligible to undergo elective orthopaedic surgery with the beginning of the vaccination campaign. This paper could be the basis for similar documents adapted to the local healthcare systems in other countries. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Riccardo Compagnoni
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Via della Commenda 10, 20122, Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Raymond Klumpp
- Reparto di Ortopedia e Traumatologia dell`Ospedale di Treviglio-Caravaggio, ASST Bergamo Ovest, Piazzale Ospedale Luigi Meneguzzo, 24047, Treviglio, Italy
| | - Mario Ronga
- Orthopaedic and Trauma Operative Unit, Department of Health Sciences, University of Eastern Piedmont, Novara - Italy. "Maggiore della Carità" Hospital, Corso Mazzini n.18, 28100, Novara, Italy
| | - Massimo Berruto
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Giovanni Di Giacomo
- Department of Orthopaedic and Trauma Surgery, Concordia Hospital for Special Surgery, 00145, Rome, Italy
| | - Pietro S Randelli
- 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
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168
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Adams AJ, Dohse N, Miller A, Tosti R. Pulmonary Complications and Mortality in Patients with SARS-CoV-2 Undergoing Elective and Emergent Hand Surgery. J Hand Microsurg 2023; 15:371-375. [PMID: 38152673 PMCID: PMC10751195 DOI: 10.1055/s-0043-1760765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Patients acutely infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have increased risk for postsurgical pulmonary complications and mortality, particularly with general anesthesia. Surgery is often delayed to mitigate risk; however, excessive delays may result in morbidity. Optimal criteria for delaying surgery in patients with or without symptoms are unknown. This study aimed to evaluate any complications following hand surgery in patients testing positive for SARS-CoV-2. Methods We retrospectively reviewed patients with a positive polymerase chain reaction test within 60 days before or after hand surgery between March 31, 2020 and March 31, 2021. Patients were telephoned also to supplement records. Type of surgery, type of anesthesia, comorbidities, timing of surgery, onset of symptoms, and complications were recorded. Results We identified 21 patients undergoing 26 procedures, of which 21 (81%) were emergency procedures and 5 (19%) were elective. Mean age was 37 years (range: 17-71). General anesthesia was used in 88% of cases, with mean duration of 110 minutes. SARS-CoV-2 was diagnosed on average 6 days preoperatively (range: 39 days preop-14 days postop). Positive tests were usually identified preoperatively (50%), versus day-of-surgery (25%) or postoperatively (25%). Patients were symptomatic in only 27% of cases, and completely asymptomatic in 73%. No asymptomatic patients developed complications. One patient suffered a fracture malunion after delayed surgery. Pulmonary complications were noted in 3 patients; all had prior pulmonary disease and underwent emergency surgeries under general anesthesia. Overall mortality rate was 0%. Conclusion Pulmonary complications and mortality are low following hand surgery in asymptomatic patients with a positive SARS-CoV-2 test.
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Affiliation(s)
- Alexander J. Adams
- Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Nicolas Dohse
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, King of Prussia, Pennsylvania, United States
| | - Andrew Miller
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, King of Prussia, Pennsylvania, United States
| | - Rick Tosti
- Philadelphia Hand to Shoulder Center, Thomas Jefferson University, King of Prussia, Pennsylvania, United States
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169
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Das G, Talukdar A, Bhutia K, Talukdar A. Outcomes of Patients Undergoing Major Surgery for Cancer with COVID-19 in the Postoperative Period. Indian J Surg Oncol 2023; 14:876-880. [PMID: 38187838 PMCID: PMC10766581 DOI: 10.1007/s13193-023-01797-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 07/04/2023] [Indexed: 01/09/2024] Open
Abstract
The aim of our study was to report about the clinical outcomes of patients who underwent major surgery for cancer and developed COVID-19 in the postoperative period. A retrospective and observational study was done in the Surgical Oncology Division of a tertiary care cancer hospital in North-East India. The study period was from 1st April 2020 to 31st December 2021. Patients with a confirmed diagnosis of cancer who underwent a major surgery and developed COVID-19 in the postoperative period, within the same hospital stay were included in the study. Data was obtained from a prospectively maintained database and case records. Descriptive statistics were used to state the results in median values, range and percentages. A total of 22 patients developed COVID-19 in the postoperative period during the study period out of a total of 1402 patients operated during that time period (1.57%). The have been followed up for a median period of 16 months (range 2 to 18 months). The median age at presentation was 50 years (range 25 to 74 years). The incidence of co-morbidities was 27.3%. The median duration of ICU stay was 3 days (range 0 to 9 days) and median duration of hospital stay was 22 days (range 9 to 55 days).. The postoperative mortality rate was 18.2%. COVID-19 in the postoperative period in patients undergoing major abdominal and thoracic surgeries for cancer caused high postoperative mortality and prolonged hospital stay.
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Affiliation(s)
- Gaurav Das
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 30, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Amrita Talukdar
- Department of Microbiology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Karma Bhutia
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 30, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
| | - Abhijit Talukdar
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute (a unit of Tata Memorial Centre), Room No. 28, AK Azad Road, Gopinath Nagar, Guwahati, Assam 781016 India
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170
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Elbanna R, Osman KA, Salama MS. Biomarkers of oral subacute toxicity of deltamethrin in exposed male Albino rats. Toxicol Ind Health 2023; 39:735-753. [PMID: 37877786 DOI: 10.1177/07482337231209360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Deltamethrin is one of the most effective pyrethroid compounds, widely employed in veterinary medicine, public health, and farming. Deltamethrin-triggered oxidative stress largely causes serious harm to an organism. Acute toxicity of this compound was extensively investigated, while less information is available on its oral sub-acute effects. This study assessed, in the male Albino rats, the effects of oral gavage of either 0.874 mg/kg (0.01 LD50) or 8.740 mg/kg (0.10 LD50) of deltamethrin for successive 14 days to investigate its effects on biomarkers and to detect the tissue injury in rats following subacute deltamethrin treatment. It was found that levels of glutathione peroxidase, superoxide dismutase, and catalase in the brain, kidney, and liver, alkaline phosphatase (ALP), and uric acid in serum, hematocrit, mean corpuscular volume (MCV), white blood cells (WBC)s, eosinophils, and basophils were significantly reduced compared with untreated rats. However, when rats were treated with deltamethrin for successive 14 days, alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) activities in serum and the levels of thiobarbituric acid reactive substances (TBARs) in brain, kidney, and liver, red blood cell distribution width (RDW-CV), total protein, monocytes, and basophils and the ratios of neutrophils to lymphocytes, an aggregated marker of systemic inflammation and systemic immune inflammation indexes, significantly increased compared with the control group. Histologic lesions were observed in the liver, kidney, brain, testis, and epidemies in rats exposed to subacute deltamethrin for 14 days, and most tissues of rats treated with 0.10 LD50 of deltamethrin were more affected than those treated with 0.01 LD50. These findings strongly suggest that subacute exposure to deltamethrin caused significant systemic toxicity through oxidative stress resulting in biochemical and histological changes in the studied tissues. These findings highlight the potential harmful effects of deltamethrin and emphasize the importance of understanding the subacute effects of this compound, particularly in the context of veterinary medicine, public health, and farming.
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Affiliation(s)
- Rania Elbanna
- Department of Pesticide Chemistry and Technology, Faculty of Agriculture, Alexandria University, Alexandria, Egypt
| | - Khaled A Osman
- Department of Pesticide Chemistry and Technology, Faculty of Agriculture, Alexandria University, Alexandria, Egypt
| | - Maher S Salama
- Department of Pesticide Chemistry and Technology, Faculty of Agriculture, Alexandria University, Alexandria, Egypt
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171
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Hacihasanoglu E, Pasaoglu E, Cin M, Yarikkaya E, Dursun N, Baykal Koca S. Can the sampling method affect the detection of incidental gallbladder carcinoma? Comparative analysis of two sampling methods. Ann Diagn Pathol 2023; 67:152187. [PMID: 37625264 DOI: 10.1016/j.anndiagpath.2023.152187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/28/2023] [Accepted: 07/30/2023] [Indexed: 08/27/2023]
Affiliation(s)
- Ezgi Hacihasanoglu
- Department of Pathology, Yeditepe University School of Medicine, Istanbul, Turkiye
| | - Esra Pasaoglu
- Department of Pathology, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, Turkiye
| | - Merve Cin
- Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkiye
| | - Enver Yarikkaya
- Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkiye
| | - Nevra Dursun
- Department of Pathology, University of Health Sciences, Basaksehir Cam ve Sakura City Hospital, Istanbul, Turkiye.
| | - Sevim Baykal Koca
- Department of Pathology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkiye
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172
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Madera‐Sandoval RL, Cérbulo‐Vázquez A, Arriaga‐Pizano LA, Cabrera‐Rivera GL, Basilio‐Gálvez E, Miranda‐Cruz PE, García de la Rosa MT, Prieto‐Chávez JL, Rivero‐Arredondo SV, Cruz‐Cruz A, Rodríguez‐Hernández D, Salazar‐Ríos ME, Salazar‐Ríos E, Serrano‐Molina ED, De Lira‐Barraza RC, Villanueva‐Compean AH, Esquivel‐Pineda A, Ramírez‐Montes de Oca R, Unzueta‐Marta O, Flores‐Padilla G, Anda‐Garay JC, Sánchez‐Hurtado LA, Calleja‐Alarcón S, Romero‐Gutiérrez L, Torres‐Rosas R, Bonifaz LC, Pelayo R, Márquez‐Márquez E, López‐Macías CIIIR, Ferat‐Osorio E. Potential biomarkers for fatal outcome prognosis in a cohort of hospitalized COVID-19 patients with pre-existing comorbidities. Clin Transl Sci 2023; 16:2687-2699. [PMID: 37873554 PMCID: PMC10719476 DOI: 10.1111/cts.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/27/2023] [Accepted: 10/01/2023] [Indexed: 10/25/2023] Open
Abstract
The difficulty in predicting fatal outcomes in patients with coronavirus disease 2019 (COVID-19) impacts the general morbidity and mortality due to severe acute respiratory syndrome-coronavirus 2 infection, as it wears out the hospital services that care for these patients. Unfortunately, in several of the candidates for prognostic biomarkers proposed, the predictive power is compromised when patients have pre-existing comorbidities. A cohort of 147 patients hospitalized for severe COVID-19 was included in a descriptive, observational, single-center, and prospective study. Patients were recruited during the first COVID-19 pandemic wave (April-November 2020). Data were collected from the clinical history whereas immunophenotyping by multiparameter flow cytometry analysis allowed us to assess the expression of surface markers on peripheral leucocyte. Patients were grouped according to the outcome in survivors or non-survivors. The prognostic value of leucocyte, cytokines or HLA-DR, CD39, and CD73 was calculated. Hypertension and chronic renal failure but not obesity and diabetes were conditions more frequent among the deceased patient group. Mixed hypercytokinemia, including inflammatory (IL-6) and anti-inflammatory (IL-10) cytokines, was more evident in deceased patients. In the deceased patient group, lymphopenia with a higher neutrophil-lymphocyte ratio (NLR) value was present. HLA-DR expression and the percentage of CD39+ cells were higher than non-COVID-19 patients but remained similar despite the outcome. Receiver operating characteristic analysis and cutoff value of NLR (69.6%, 9.4), percentage NLR (pNLR; 71.1%, 13.6), and IL-6 (79.7%, 135.2 pg/mL). The expression of HLA-DR, CD39, and CD73, as many serum cytokines (other than IL-6) and chemokines levels do not show prognostic potential, were compared to NLR and pNLR values.
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Affiliation(s)
- Ruth Lizzeth Madera‐Sandoval
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | - Lourdes Andrea Arriaga‐Pizano
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Graciela Libier Cabrera‐Rivera
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Edna Basilio‐Gálvez
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado de Ciencias Químicobiológicas, Escuela Nacional de Ciencias BiológicasInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Patricia Esther Miranda‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Teresa García de la Rosa
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Posgrado en InmunologíaInstituto Politécnico NacionalCiudad de MéxicoMexico
| | - Jessica Lashkmin Prieto‐Chávez
- Centro de Instrumentos, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Silvia Vanessa Rivero‐Arredondo
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Alonso Cruz‐Cruz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Daniela Rodríguez‐Hernández
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - María Eugenia Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Enrique Salazar‐Ríos
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Esli David Serrano‐Molina
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | | | | | - Alejandra Esquivel‐Pineda
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rubén Ramírez‐Montes de Oca
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Omar Unzueta‐Marta
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Guillermo Flores‐Padilla
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Juan Carlos Anda‐Garay
- Medicina Interna, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Luis Alejandro Sánchez‐Hurtado
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Salvador Calleja‐Alarcón
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Laura Romero‐Gutiérrez
- Unidad de Cuidados Intensivos, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
| | - Rafael Torres‐Rosas
- Laboratorio de Inmunología, Centro de Estudios en Ciencias de la Salud y la Enfermedad, Facultad de OdontologíaUniversidad Autónoma “Benito Juárez” de Oaxaca (UABJO)Oaxaca de JuárezMexico
| | - Laura C. Bonifaz
- Unidad de Investigación Médica en Inmunoquímica, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
| | - Rosana Pelayo
- Centro de Investigación Biomédica de OrienteIMSSPueblaMexico
- Unidad de Educación e Investigación, IMSSCiudad de MéxicoMexico
| | | | | | - Eduardo Ferat‐Osorio
- Coordinación de Investigación en Salud, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro SocialCiudad de MéxicoMexico
- División de Investigación en Salud, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXIInstituto Mexicano del Seguro Social (IMSS)Ciudad de MéxicoMexico
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173
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Levitt EB, Patch DA, Hess MC, Terrero A, Jaeger B, Haendel MA, Chute CG, Yeager MT, Ponce BA, Theiss SM, Spitler CA, Johnson JP. Outcomes of SARS-CoV-2 infection among patients with orthopaedic fracture surgery in the National COVID Cohort Collaborative (N3C). Injury 2023; 54:111092. [PMID: 37871347 DOI: 10.1016/j.injury.2023.111092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND The objective of this study was to investigate the outcomes of COVID-19-positive patients undergoing orthopaedic fracture surgery using data from a national database of U.S. adults with a COVID-19 test for SARS-CoV-2. METHODS This is a retrospective cohort study using data from a national database to compare orthopaedic fracture surgery outcomes between COVID-19-positive and COVID-19-negative patients in the United States. Participants aged 18-99 with orthopaedic fracture surgery between March and December 2020 were included. The main exposure was COVID-19 status. Outcomes included perioperative complications, 30-day all-cause mortality, and overall all-cause mortality. Multivariable adjusted models were fitted to determine the association of COVID-positivity with all-cause mortality. RESULTS The total population of 6.5 million patient records was queried, identifying 76,697 participants with a fracture. There were 7,628 participants in the National COVID Cohort who had a fracture and operative management. The Charlson Comorbidity Index was higher in the COVID-19-positive group (n = 476, 6.2 %) than the COVID-19-negative group (n = 7,152, 93.8 %) (2.2 vs 1.4, p<0.001). The COVID-19-positive group had higher mortality (13.2 % vs 5.2 %, p<0.001) than the COVID-19-negative group with higher odds of death in the fully adjusted model (Odds Ratio=1.59; 95 % Confidence Interval: 1.16-2.18). CONCLUSION COVID-19-positive participants with a fracture requiring surgery had higher mortality and perioperative complications than COVID-19-negative patients in this national cohort of U.S. adults tested for COVID-19. The risks associated with COVID-19 can guide potential treatment options and counseling of patients and their families. Future studies can be conducted as data accumulates. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Eli B Levitt
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA; Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA
| | - David A Patch
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Matthew C Hess
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Alfredo Terrero
- Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, FL, USA; Department of Translational Medicine, School of Medicine, University of Miami Miller, Miami, FL, USA
| | - Byron Jaeger
- Department of Epidemiology, University of Alabama, Birmingham, AL, USA
| | - Melissa A Haendel
- Center for Health AI, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew T Yeager
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | | | - Steven M Theiss
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Clay A Spitler
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA
| | - Joey P Johnson
- Department of Orthopaedic Surgery, University of Alabama, Birmingham, AL, USA.
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174
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Momeeh MY, Alrumayh MM, Ahmed K, Alharbi FL. Postoperative Complications in Patients With the Preoperative COVID-19 Infection at King Fahad Specialist Hospital: A Retrospective Cohort Study. Cureus 2023; 15:e50037. [PMID: 38186544 PMCID: PMC10768319 DOI: 10.7759/cureus.50037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) is an infectious disease caused by a new coronavirus strain. Indeed, the timing of COVID-19 infection before surgery plays an important role in the surgery outcomes and complications. OBJECTIVE In this study, we aimed to assess the prevalence and predictors of postoperative complications for patients who underwent surgery with previous COVID-19 infection. METHODOLOGY This was a retrospective hospital-based study which was conducted on 75 patients who had been infected with COVID-19 and underwent surgery. RESULTS We included 75 patients. The time between COVID-19 infection and the surgery was from one to six months in 52% of patients, 24% of patients were more than six months, and 24% of patients were less than one month. In this study, most of the patients had no complications (77.3%) while 22.7% of patients had complications that were mainly respiratory (n= 13). The overall mortality in our study was 5.3%. There was a significant association between comorbidity and postoperative complications, and the status of COVID-19 preoperative and postoperative complications (p < 0.01) but not patients' age as well as the type of anesthesia and postoperative complication (p > 0.05). CONCLUSION Respiratory complications were the most common postoperative complications in patients who had surgery after COVID-19 infection. Comorbidity and COVID-19 status were significantly associated with higher postoperative complications. Mortality was relatively small. We recommend extreme care to patients with COVID-19 infection prior to surgery to decrease the COVID-19 hazards that develop post-surgery.
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Affiliation(s)
| | | | - Khiloud Ahmed
- Anesthesia, Maternity and Children Hospital, Buraidah, SAU
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175
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Kim IK, Kwag SJ, Kim HG, Ju YT, Lee SJ, Park TJ, Jeong SH, Jung EJ, Lee JK. Perioperative considerations for acute appendicitis in patients with COVID-19 infection: two case reports. Ann Coloproctol 2023; 39:521-525. [PMID: 34871490 PMCID: PMC10781601 DOI: 10.3393/ac.2021.00647.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 10/19/2022] Open
Abstract
We report considerations related with surgery through 2 cases of acute apendicitis with COVID-19 infection. In November and December 2020, two patients infected with COVID-19 developed acute apendicitis and underwent emergency surgery. In case 1, an 84-year-old woman was asymptomatic and diagnosed with acute apendicitis on the 20th day of infection. She was discharged after surgery without complication. In contrast, case 2 was a 69-year-old male patient with pneumonia treated with antibiotics, steroids and remdesivir. After surgery, he was hospitalized for a long duration due to persistent pneumonia and wound complications. We should perform appendectomy in well-established negative pressure operating rooms, personal protective equipment, and protocols. Since the physical examination and blood tests were limited, image examination like computed tomography scan should be considered if acute apendicitis is suspected. If the patient has pneumonia before surgery, it can get worse after surgery, and complications such as wound infections can occur.
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Affiliation(s)
- In-Kyeong Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Seung-jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Han-Gil Kim
- Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung-Jun Lee
- Department of Convergence Medical Science, Gyeongsang National University, Jinju, Korea
| | - Tae-Jin Park
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Sang-Ho Jeong
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Eun-Jung Jung
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jin-Kwon Lee
- Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, Korea
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176
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Martins JP, Siqueira BA, Sansone NMS, Marson FAL. COVID-19 in Brazil: a 3-year update. Diagn Microbiol Infect Dis 2023; 107:116074. [PMID: 37729718 DOI: 10.1016/j.diagmicrobio.2023.116074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
Three years into the coronavirus disease (COVID)-19 pandemic and the world is still struggling with the aftermath of this global health crisis. In Brazil, we are witnessing serious economic, health, social, and political problems. The rapid spread of the virus in our country was the result of a shortage of vaccines and the lack of an effective national campaign to identify and report cases. This health crisis also intensified social inequalities, hitting Indigenous peoples hard due to the lack of access to health services. In addition, rising unemployment and overcrowding of the health system made contagion possible, especially among the most vulnerable, increasing the number of serious cases of the disease. It is important to highlight that emotional problems worsened, the educational system was severely affected, and domestic violence increased during the confinement period, in addition to the fact that the pandemic exposed the great disparities of regional inequalities that exist across the country, mainly concerning health management.
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Affiliation(s)
- Jéssica Paula Martins
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
| | - Bianca Aparecida Siqueira
- Laboratory of Molecular Biology and Genetics, São Francisco University, Bragança Paulista, São Paulo, Brazil
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Zhang F, Di L, Jiang S, Wang S, Tian MW, Liang Z, Wu W, Li Y, Zhang J, Huang L. Eligibility for elective surgery in patients recovering from mild COVID-19: A propensity-matched analysis. J Surg Oncol 2023; 128:1219-1226. [PMID: 37638392 DOI: 10.1002/jso.27425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To study the timing of surgery after a recent Omicron variant infection, to provide a reference for policymakers, clinicians, and patients. METHODS This single-center propensity-matched analysis was designed and reported according to the EQUATOR-STROBE guidelines. Patients recovering from COVID-19 infection were divided into three groups based on the period from disappearance of respiratory symptoms to surgery: ≤7 days, 8-14 days, and >14 days groups. Outcome measures included postoperative respiratory complications, vascular thrombosis, myocardial infarction, ischemic stroke, and mortality. RESULTS Between August 1 and December 31, 2022, 9023 surgical procedures were performed, of which 7490 surgeries met the inclusion criteria. Propensity matching resulted in a final cohort of 227 patients recovered from COVID-19 and 2043 SARS-CoV-2 negative patients. Compared with the SARS-CoV-2 negative group, the incidence of postoperative respiratory complications was significantly higher (15.91% vs. 6.71%, p = 0.028) only in the ≤7 days group. There were no statistically significant differences in the other 30-day outcomes between the SARS-CoV-2 negative and the three COVID-19 recovery groups. CONCLUSIONS Patients who have recovered from mild COVID-19 may be eligible for elective surgery at least 7 days after recovery, since they do not have an increased risk of postoperative complications or mortality within 30 days.
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Affiliation(s)
- Fuzhen Zhang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Lichao Di
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Sufang Jiang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Shizhao Wang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Meng-Wu Tian
- Department of Critical Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Zhi Liang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Wenhao Wu
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yongxin Li
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Jiaqi Zhang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Lining Huang
- Department of Anesthesiology, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Whyne CM, Underwood G, Davidson SRH, Robert N, Huang C, Akens MK, Fichtinger G, Yee AJM, Hardisty M. Development and validation of a radiofrequency ablation treatment planning system for vertebral metastases. Int J Comput Assist Radiol Surg 2023; 18:2339-2347. [PMID: 37245180 DOI: 10.1007/s11548-023-02952-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/05/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE Bone-targeted radiofrequency ablation (RFA) is widely used in the treatment of vertebral metastases. While radiation therapy utilizes established treatment planning systems (TPS) based on multimodal imaging to optimize treatment volumes, current RFA of vertebral metastases has been limited to qualitative image-based assessment of tumour location to direct probe selection and access. This study aimed to design, develop and evaluate a computational patient-specific RFA TPS for vertebral metastases. METHODS A TPS was developed on the open-source 3D slicer platform, including procedural setup, dose calculation (based on finite element modelling), and analysis/visualization modules. Usability testing was carried out by 7 clinicians involved in the treatment of vertebral metastases on retrospective clinical imaging data using a simplified dose calculation engine. In vivo evaluation was performed in a preclinical porcine model (n = 6 vertebrae). RESULTS Dose analysis was successfully performed, with generation and display of thermal dose volumes, thermal damage, dose volume histograms and isodose contours. Usability testing showed an overall positive response to the TPS as beneficial to safe and effective RFA. The in vivo porcine study showed good agreement between the manually segmented thermally damaged volumes vs. the damage volumes identified from the TPS (Dice Similarity Coefficient = 0.71 ± 0.03, Hausdorff distance = 1.2 ± 0.1 mm). CONCLUSION A TPS specifically dedicated to RFA in the bony spine could help account for tissue heterogeneities in both thermal and electrical properties. A TPS would enable visualization of damage volumes in 2D and 3D, assisting clinicians in decisions about potential safety and effectiveness prior to performing RFA in the metastatic spine.
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Affiliation(s)
- Cari M Whyne
- Orthopaedic Biomechanics Lab, Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada.
| | - Grace Underwood
- School of Computing, Queen's University, Kingston, ON, Canada
| | | | - Normand Robert
- Orthopaedic Biomechanics Lab, Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Christine Huang
- Orthopaedic Biomechanics Lab, Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Margarete K Akens
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Techna Institute, University Health Network, Toronto, ON, Canada
| | | | - Albert J M Yee
- Orthopaedic Biomechanics Lab, Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Michael Hardisty
- Orthopaedic Biomechanics Lab, Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
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179
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García-Botella A, De la Serna Esteban S, López-Antoñanzas L, Avellana-Moreno R, Dziakova J, Cano Valderrama O, Martín-Antona E, Serrano-García I, Torres García AJ. Lessons Learned in Elective Surgeries After 6 Pandemic Waves of SARS-CoV-2. A Single European Center Experience. World J Surg 2023; 47:2958-2965. [PMID: 37875666 DOI: 10.1007/s00268-023-07222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The reported high surgical morbidity and mortality in patients with SARS-CoV-2 prompted preoperative screening and modification of surgical protocols. Although vaccination and treatment of COVID-19 have resulted in lower hospitalization rates and infection severity, publications on postoperative results have not been updated. The aim of the study was to analyze the outcomes of patients undergoing surgery in two periods with high incidence of SARS-CoV-2 infection, before and after vaccination. MATERIALS AND METHODS This is a prospective cohort study of patients undergoing surgery in two periods: March-June 2020 (Group2020) and December 2021-February 2022 (Group2022) (after massive vaccination). RESULTS In total, 618 patients who underwent surgery were included in the analysis (Group2020: 343 vs. Group2022: 275). Significantly more oncological procedures were performed in Group2020, and there were no differences in postoperative complications. Nosocomial SARS-CoV-2 infection occurred in 4 patients in Group2020 and 1 patient in Group2022. In Group 2022, 70 patients (25.4%) had COVID-19 prior to surgery, and 68 (97.1%) were vaccinated. Comparative analysis between patients with past COVID-19 and those without showed no difference in postoperative morbidity and mortality. According to the time elapsed between SARS-CoV-2 infection and surgery (≤ 7 or > 7 weeks), comparative analysis showed no significant differences. CONCLUSION The establishment of preoperative screening protocols for SARS-CoV-2 infection results in a low incidence of nosocomial infection and optimal postoperative outcomes. Preoperative SARS-CoV-2 infection in vaccinated patients was not associated with increased postoperative complications, even in shorter periods after infection. In surgical patients, individualized preoperative evaluation after SARS-CoV-2 infection may be more important than strict time limitation.
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Affiliation(s)
- Alejandra García-Botella
- Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain.
- Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain.
| | - Sofía De la Serna Esteban
- Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain
- Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Leyre López-Antoñanzas
- Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Rocío Avellana-Moreno
- Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Jana Dziakova
- Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain
- Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Oscar Cano Valderrama
- Department of Surgery, Vigo; Instituto de Investigaciones Sanitarias Galicia Sur, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Esteban Martín-Antona
- Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain
| | - Irene Serrano-García
- IdISSC, Methodological Research Support Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Antonio José Torres García
- Surgery Department (HepatoPancreatoBiliary Unit), Health Research Institute (IdISSC), Hospital Clínico San Carlos, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain
- Department of Surgery, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
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Del Rey de Diego P, Martínez García E, Tormo de Las Heras C, García Fernández E. Adaptation to a monography pediatric hospital of the recommendations for the early detection of active COVID-19 infection prior to hospital admission, performance of diagnostic tests and surgical procedures. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:608-609. [PMID: 37678463 DOI: 10.1016/j.redare.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 09/09/2023]
Affiliation(s)
- P Del Rey de Diego
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - E Martínez García
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - C Tormo de Las Heras
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - E García Fernández
- Servicio de Anestesia y Reanimación, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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181
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D'Souza DL, Ragulojan R, Guo C, Dale CM, Jones CJ, Talaie R. Thermal Ablation in the Liver: Heat versus Cold-What Is the Role of Cryoablation? Semin Intervent Radiol 2023; 40:491-496. [PMID: 38274220 PMCID: PMC10807970 DOI: 10.1055/s-0043-1777845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Cryoablation is commonly used in the kidney, lung, breast, and soft tissue, but is an uncommon choice in the liver where radiofrequency ablation (RFA) and microwave ablation (MWA) predominate. This is in part for historical reasons due to serious complications that occurred with open hepatic cryoablation using early technology. More current technology combined with image-guided percutaneous approaches has ameliorated these issues and allowed cryoablation to become a safe and effective thermal ablation modality for treating liver tumors. Cryoablation has several advantages over RFA and MWA including the ability to visualize the ice ball, minimal procedural pain, and strong immunomodulatory effects. This article will review the current literature on cryoablation of primary and secondary liver tumors, with a focus on efficacy, safety, and immunogenic potential. Clinical scenarios when it may be more beneficial to use cryoablation over heat-based ablation in the liver, as well as directions for future research, will also be discussed.
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Affiliation(s)
- Donna L. D'Souza
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Ranjan Ragulojan
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Chunxiao Guo
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Connie M. Dale
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Christopher J. Jones
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
| | - Reza Talaie
- Division of Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, Minnesota
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182
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Kamal O, Horvat N, Arora S, Chaudhry H, Elmohr M, Khanna L, Nepal PS, Wungjramirun M, Nandwana SB, Shenoy-Bhangle AS, Lee J, Kielar A, Marks R, Elsayes K, Fung A. Understanding the role of radiologists in complex treatment decisions for patients with hepatocellular carcinoma. Abdom Radiol (NY) 2023; 48:3677-3687. [PMID: 37715846 DOI: 10.1007/s00261-023-04033-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/18/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and represents a significant global health burden. Management of HCC can be challenging due to multiple factors, including variable expectations for treatment outcomes. Several treatment options are available, each with specific eligibility and ineligibility criteria, and are provided by a multidisciplinary team of specialists. Radiologists should be aware of the types of treatment options available, as well as the criteria guiding the development of individualized treatment plans. This awareness enables radiologists to contribute effectively to patient-centered multidisciplinary tumor boards for HCC and play a central role in reassessing care plans when the treatment response is deemed inadequate. This comprehensive review aims to equip radiologists with an overview of HCC staging systems, treatment options, and eligibility criteria. The review also discusses the significance of imaging in HCC diagnosis, treatment planning, and monitoring treatment response. Furthermore, we highlight the crucial branch points in the treatment decision-making process that depend on radiological interpretation.
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Affiliation(s)
- Omar Kamal
- Department of Diagnostic Radiology, Oregon Health & Science University, Mail Code: L340, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Natally Horvat
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | - Manida Wungjramirun
- Department of Diagnostic Radiology, Oregon Health & Science University, Mail Code: L340, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | | | | | - James Lee
- University of Kentucky, Lexington, KY, USA
| | | | | | | | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health & Science University, Mail Code: L340, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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183
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Pigg N, Ward RC. Cryoablation for the Treatment of Breast Cancer: A Review of the Current Landscape and Future Possibilities. Acad Radiol 2023; 30:3086-3100. [PMID: 37596141 DOI: 10.1016/j.acra.2023.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 08/20/2023]
Abstract
Breast cancer is one of the most common malignancies worldwide. Traditional treatment options for breast cancer include surgery, radiation therapy, and chemotherapy. However, cryoablation, a minimally invasive technique, has emerged as a promising alternative for the treatment of early-stage breast cancer. This article aims to provide an overview of cryoablation, focusing on incorporation into practice, patient selection, procedural technique, imaging follow-up, post-treatment radiopathological findings, and current and ongoing research in the field. The current evidence suggests that cryoablation offers a safe and effective treatment option for selected patients, providing comparable oncological outcomes to traditional treatments while minimizing invasiveness and preserving breast aesthetics.
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Affiliation(s)
- Nicholas Pigg
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Women & Infants Hospital, Providence, Rhode Island.
| | - Robert C Ward
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Rhode Island Hospital, Women & Infants Hospital, Providence, Rhode Island
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184
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Payton O, Prakash R, Shaikh A, Hassan MF, Haleem S. Experience of Spinal Surgery for the Over 70s During the COVID-19 Pandemic in a Tertiary Referral Centre in the United Kingdom and Ramifications for Future Management. Cureus 2023; 15:e51017. [PMID: 38264388 PMCID: PMC10804174 DOI: 10.7759/cureus.51017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION The aim of this study was to assess the safety of our spinal surgery pathways for patients over the age of 70 years during the COVID-19 pandemic, to guide future management. METHODS A retrospective, single-centre, observational cohort study of all patients over 70 years of age undergoing spinal surgery between June 1 to September 30, 2020, was performed. All patients were stratified by the British Orthopaedic Association (BOA) COVID-19 Patient Risk Assessment Tool. RESULTS A total of 64 operations on 59 patients were performed. The BOA risk assessment placed 67.8% of patients (n=40) in the high or very high-risk category. A total of 60% of patients (n=36) were over 75 years old. All patients had at least one other comorbidity. Following our green, amber, and red pathways, we had no cases of post-operative COVID-19 on an average follow-up of 71 days. CONCLUSION Our study illustrates safe pathways for spinal surgery on patients over 70 years old during the first wave of COVID-19. Risk assessment tools should be used with caution, as age over 65 years was immediately medium-risk. This study would be a useful guide in the management of all elderly patients requiring surgery in the face of further COVID-19 variants or a similar pandemic.
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Affiliation(s)
- Olivia Payton
- Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, GBR
| | - Rohan Prakash
- Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, GBR
| | - Adnan Shaikh
- Spinal Surgery, Royal Orthopaedic Hospital, Birmingham, GBR
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185
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Thai JN, Sevrukov AB, Ward RC, Monticciolo DL. Cryoablation Therapy for Early-Stage Breast Cancer: Evidence and Rationale. J Breast Imaging 2023; 5:646-657. [PMID: 38141236 DOI: 10.1093/jbi/wbad064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Indexed: 12/25/2023]
Abstract
Recent advances in breast cancer research and treatment propel a paradigm shift toward less aggressive and less invasive treatment for some early-stage breast cancer. Select patients with small, low-risk tumors may benefit from a less aggressive approach with de-escalated local therapy. Cryoablation of breast cancer is an emerging nonsurgical treatment alternative to breast-conserving surgery. Advantages of cryoablation over surgery include the use of local anesthesia, faster recovery, improved cosmesis, and cost savings. Proper patient selection and meticulous technique are keys to achieving successful clinical outcomes. The best candidates for cryoablation have unifocal invasive ductal carcinoma tumors that are low grade, hormone receptor positive, and ≤1.5 cm in size. In this review, we outline the current evidence, patient selection criteria, procedural technique, pre- and postablation imaging, and the advantages and limitations of cryoablation therapy.
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Affiliation(s)
- Janice N Thai
- Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Division of Breast Imaging, Boston, MA, USA
| | - Alexander B Sevrukov
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Department of Radiology, Division of Breast Imaging, Philadelphia, PA, USA
| | - Robert C Ward
- The Warren Alpert Medical School of Brown University, Rhode Island Hospital and Women and Infants Hospital, Department of Diagnostic, Imaging, Division of Breast Imaging, Providence, RI, USA
| | - Debra L Monticciolo
- Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Division of Breast Imaging, Boston, MA, USA
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186
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Reyes-Ruiz JM, García-Hernández O, Martínez-Mier G, Osuna-Ramos JF, De Jesús-González LA, Farfan-Morales CN, Palacios-Rápalo SN, Cordero-Rivera CD, Ordoñez-Rodríguez T, del Ángel RM. The Role of Aspartate Aminotransferase-to-Lymphocyte Ratio Index (ALRI) in Predicting Mortality in SARS-CoV-2 Infection. Microorganisms 2023; 11:2894. [PMID: 38138038 PMCID: PMC10745537 DOI: 10.3390/microorganisms11122894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 12/24/2023] Open
Abstract
COVID-19 has a mortality rate exceeding 5.4 million worldwide. The early identification of patients at a high risk of mortality is essential to save their lives. The AST-to-lymphocyte ratio index (ALRI) is a novel biomarker of survival in patients with hepatocellular carcinoma, an organ susceptible to SARS-CoV-2 infection. For this study, the prognostic value of ALRI as a marker of COVID-19 mortality was evaluated. For this purpose, ALRI was compared with the main biomarkers for COVID-19 mortality (neutrophil-to-lymphocyte ratio [NLR], systemic immune-inflammation index [SII], platelet-to-lymphocyte ratio [PLR], lactate dehydrogenase (LDH)/lymphocyte ratio [LDH/LR]). A retrospective cohort of 225 patients with SARS-CoV-2 infection and without chronic liver disease was evaluated. In the non-survival group, the ALRI, NLR, SII, and LDH/LR were significantly higher than in the survival group (pcorrected < 0.05). ALRI had an area under the curve (AUC) of 0.81, a sensitivity of 70.37%, and a specificity of 75%, with a best cut-off value >42.42. COVID-19 patients with high ALRI levels had a mean survival time of 7.8 days. Multivariate Cox regression revealed that ALRI > 42.42 (HR = 2.32, 95% CI: 1.35-3.97; pcorrected = 0.01) was a prognostic factor of COVID-19 mortality. These findings prove that ALRI is an independent predictor of COVID-19 mortality and that it may help identify high-risk subjects with SARS-CoV-2 infection upon admission.
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Affiliation(s)
- José Manuel Reyes-Ruiz
- Department of Research, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz 91897, Mexico;
| | - Omar García-Hernández
- Department of Internal Medicine, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz 91897, Mexico; (O.G.-H.); (T.O.-R.)
| | - Gustavo Martínez-Mier
- Department of Research, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz 91897, Mexico;
| | | | | | - Carlos Noe Farfan-Morales
- Departamento de Ciencias Naturales, Universidad Autónoma Metropolitana (UAM), Unidad Cuajimalpa, Mexico City 05348, Mexico;
| | - Selvin Noé Palacios-Rápalo
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City 07360, Mexico; (S.N.P.-R.); (C.D.C.-R.); (R.M.d.Á.)
| | - Carlos Daniel Cordero-Rivera
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City 07360, Mexico; (S.N.P.-R.); (C.D.C.-R.); (R.M.d.Á.)
| | - Tatiana Ordoñez-Rodríguez
- Department of Internal Medicine, Unidad Médica de Alta Especialidad, Hospital de Especialidades No. 14, Centro Médico Nacional “Adolfo Ruiz Cortines”, Instituto Mexicano del Seguro Social (IMSS), Veracruz 91897, Mexico; (O.G.-H.); (T.O.-R.)
| | - Rosa María del Ángel
- Department of Infectomics and Molecular Pathogenesis, Center for Research and Advanced Studies (CINVESTAV-IPN), Mexico City 07360, Mexico; (S.N.P.-R.); (C.D.C.-R.); (R.M.d.Á.)
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Xia W, Jiang T, Tan Y, Li C, Wu S, Mei B. Characteristics of hematological parameters on admission in COVID-19 Omicron variant infected in Chinese population: a large-scale retrospective study. BMC Infect Dis 2023; 23:835. [PMID: 38012548 PMCID: PMC10683119 DOI: 10.1186/s12879-023-08771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The Omicron variant of SARS-CoV-2, currently the most prevalent strain, has rapidly spread in Jingzhou, China, due to changes in the country's epidemic prevention policy, resulting in an unprecedented increase in cases. Previous studies reported hematological parameters' predictive value in COVID-19 severity and prognosis, but their relevance for early diagnosis in patients infected by the Omicron variant, particularly in high-risk pneumonia cases, remains unclear. Our study aimed to evaluate these parameters as early warning indicators for Omicron-infected patients in fever clinics and those with pulmonary infections (PI). METHODS A total of 2,021 COVID-19 patients admitted to the fever clinic and infectious disease department of Jingzhou Hospital Affiliated to Yangtze University from November 1, 2022, to December 31, 2022, were retrospectively recruited. Demographic and hematological parameters were obtained from the electronic medical records of eligible patients. These hematological parameters were analyzed by receiver operating characteristic (ROC) curves to determine whether they can be used for early diagnosis of COVID-19 patients in fever clinics and the presence of PI in COVID-19 patients. RESULTS Statistical differences in hematological parameters were observed between COVID-19 patients with fever and PI and control groups (P < 0.01). The ROC curve further demonstrated that lymphocyte (LYM) counts, neutrophil (NEU) counts, monocyte-to-lymphocyte ratios (MLR), platelet-to-lymphocyte ratios (PLR), white blood cell counts (WBC), and mean corpuscular hemoglobin concentration (MCHC) were the top 6 indicators in diagnosing Omicron infection with fever, with area under the curve (AUC) values of 0.738, 0.718, 0.713, 0.702, 0.700, and 0.687, respectively (P < 0.01). Furthermore, the mean platelet volume (MPV) with an AUC of 0.764, red blood cell count (RBC) with 0.753, hematocrit (HCT) with 0.698, MLR with 0.694, mean corpuscular hemoglobin (MCH) with 0.676, and systemic inflammation response indexes (SIRI) with 0.673 were the top 6 indicators for the diagnosis of COVID-19 patients with PI (P < 0.01). CONCLUSIONS LYM, NEU, MLR, PLR, WBC, and MCHC can serve as potential prescreening indicators for Omicron infection in fever clinics. Additionally, MPV, RBC, HCT, MLR, MCH, and SIRI can predict the presence of PI in COVID-19 patients infected by the Omicron variant.
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Affiliation(s)
- Wei Xia
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, 434020, China
| | - Tao Jiang
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, 434020, China
| | - Yafeng Tan
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, 434020, China
| | - Chengbin Li
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, 434020, China
| | - Song Wu
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, 434020, China
| | - Bing Mei
- Department of Laboratory Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, 434020, China.
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Sewell B, Farr A, Akbari A, Carson-Stevens A, Dale J, Edwards A, Evans BA, John A, Torabi F, Jolles S, Kingston M, Lyons J, Lyons RA, Porter A, Watkins A, Williams V, Snooks H. The cost of implementing the COVID-19 shielding policy in Wales. BMC Public Health 2023; 23:2342. [PMID: 38008730 PMCID: PMC10680245 DOI: 10.1186/s12889-023-17169-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/06/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND The EVITE Immunity study investigated the effects of shielding Clinically Extremely Vulnerable (CEV) people during the COVID-19 pandemic on health outcomes and healthcare costs in Wales, United Kingdom, to help prepare for future pandemics. Shielding was intended to protect those at highest risk of serious harm from COVID-19. We report the cost of implementing shielding in Wales. METHODS The number of people shielding was extracted from the Secure Anonymised Information Linkage Databank. Resources supporting shielding between March and June 2020 were mapped using published reports, web pages, freedom of information requests to Welsh Government and personal communications (e.g. with the office of the Chief Medical Officer for Wales). RESULTS At the beginning of shielding, 117,415 people were on the shielding list. The total additional cost to support those advised to stay home during the initial 14 weeks of the pandemic was £13,307,654 (£113 per person shielded). This included the new resources required to compile the shielding list, inform CEV people of the shielding intervention and provide medicine and food deliveries. The list was adjusted weekly over the 3-month period (130,000 people identified by June 2020). Therefore the cost per person shielded lies between £102 and £113 per person. CONCLUSION This is the first evaluation of the cost of the measures put in place to support those identified to shield in Wales. However, no data on opportunity cost was available. The true costs of shielding including its budget impact and opportunity costs need to be investigated to decide whether shielding is a worthwhile policy for future health emergencies.
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Affiliation(s)
- Bernadette Sewell
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Angela Farr
- Swansea Centre for Health Economics, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ashley Akbari
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK
| | - Bridie Angela Evans
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ann John
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Fatemeh Torabi
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, CF14 4XW, UK
| | - Mark Kingston
- Swansea University Medical School and PRIME Centre Wales, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Jane Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Ronan A Lyons
- Population Data Science, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alison Porter
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Alan Watkins
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Victoria Williams
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
| | - Helen Snooks
- Swansea University Medical School, Faculty of Medicine, Health and Life Science, Swansea University, Singleton Park, Swansea, SA2 8PP, UK
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Uttinger KL, Brunotte M, Diers J, Lock JF, Jansen-Winkeln B, Seehofer D, Germer CT, Wiegering A. Diverticulitis patient care during the Covid-19 pandemic in Germany-a retrospective nationwide population-based cohort study. Langenbecks Arch Surg 2023; 408:447. [PMID: 38001302 PMCID: PMC10673984 DOI: 10.1007/s00423-023-03184-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
PURPOSE Coronavirus disease 2019 (COVID-19) impacted health care systems around the world. Despite a decrease in emergency admissions, an increased number of complicated forms of diverticulitis was reported. It was the aim of this study to analyze the pandemic impact on diverticulitis management in Germany. METHODS This is a retrospective population-wide analysis of hospital billing data (2012-2021) of diverticulitis in Germany. Patients were identified based on diagnosis (ICD10) and procedural codes to stratify by conservative and operative management. Primary outcome of interest was admission rates, secondary outcomes were rates of surgical vs conservative treatment and fraction of complicated clinical courses during the pandemic. RESULTS Of a total of 991,579 cases, 66,424 (6.7%) were admitted during pandemic lockdowns. Conservative treatment was the most common overall (66.9%) and higher during lockdowns (70.7%). Overall admissions and population adjusted rates of surgically treated patients decreased, the latter by 12.7% and 11.3%, corrected to estimated rates, in the two lockdowns. Surgery after emergency presentation decreased by 7.1% (p=0.053) and 11.1% (p=0.002) in the two lockdowns with a higher rate of ostomy and/or revision (+5.6%, p=0.219, and +10.2%, p=0.030). In-hospital mortality was increased in lockdown periods (1.64% vs 1.49%). In detail, mortality was identical in case of conservative treatment during lockdown periods (0.5%) but was higher in surgically treated patients (4.4% vs 3.6%). CONCLUSION During lockdowns, there was an overall decrease of admissions for diverticulitis, especially non-emergency admissions in Germany, and treatment was more likely to be conservative. In case of surgery, however, there was increased risk of a complicated course (ostomy, re-surgery), possibly due to patient selection.
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Affiliation(s)
- Konstantin L Uttinger
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany.
- Department of Visceral, Transplant, Thoracic and Vascular Surgery Leipzig University Medical Center, Leipzig, Germany.
| | - Maximilian Brunotte
- Department of Visceral, Transplant, Thoracic and Vascular Surgery Leipzig University Medical Center, Leipzig, Germany
| | - Johannes Diers
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
| | - Johan Friso Lock
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
| | - Boris Jansen-Winkeln
- Department of General, Visceral and Oncological Surgery, St. Georg Hospital Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery Leipzig University Medical Center, Leipzig, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, Würzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg Medical Center, Würzburg, Germany
- Department of Biochemistry and Molecular Biology, University of Würzburg, Würzburg, Germany
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190
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Cozzi A, Di Leo G, Houssami N, Gilbert FJ, Helbich TH, Álvarez Benito M, Balleyguier C, Bazzocchi M, Bult P, Calabrese M, Camps Herrero J, Cartia F, Cassano E, Clauser P, de Lima Docema MF, Depretto C, Dominelli V, Forrai G, Girometti R, Harms SE, Hilborne S, Ienzi R, Lobbes MBI, Losio C, Mann RM, Montemezzi S, Obdeijn IM, Aksoy Ozcan U, Pediconi F, Pinker K, Preibsch H, Raya Povedano JL, Rossi Saccarelli C, Sacchetto D, Scaperrotta GP, Schlooz M, Szabó BK, Taylor DB, Ulus SÖ, Van Goethem M, Veltman J, Weigel S, Wenkel E, Zuiani C, Sardanelli F. Preoperative breast MRI positively impacts surgical outcomes of needle biopsy-diagnosed pure DCIS: a patient-matched analysis from the MIPA study. Eur Radiol 2023:10.1007/s00330-023-10409-5. [PMID: 37999727 DOI: 10.1007/s00330-023-10409-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/16/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). METHODS The MIPA observational study database (7245 patients) was searched for patients aged 18-80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). RESULTS Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). CONCLUSIONS Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. CLINICAL RELEVANCE STATEMENT When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. KEY POINTS • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.
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Affiliation(s)
- Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
- Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy
| | - Nehmat Houssami
- The Daffodil Centre, Faculty of Medicine and Health, The University of Sydney (Joint Venture with Cancer Council NSW), Sydney, Australia
| | - Fiona J Gilbert
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Thomas H Helbich
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Division of Molecular and Structural Preclinical Imaging, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Corinne Balleyguier
- Department of Radiology, Institut Gustave Roussy, Villejuif, France
- Biomaps, UMR1281 INSERM, CEA, CNRS, Université Paris-Saclay, Villejuif, France
| | - Massimo Bazzocchi
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Peter Bult
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Massimo Calabrese
- Unit of Oncological and Breast Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Julia Camps Herrero
- Department of Radiology, Hospital Universitario de La Ribera, Alzira, Spain
- Ribera Salud Hospitals, Valencia, Spain
| | - Francesco Cartia
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Clauser
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Catherine Depretto
- Unit of Breast Imaging, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valeria Dominelli
- Breast Imaging Division, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Gábor Forrai
- Department of Radiology, MHEK Teaching Hospital, Semmelweis University, Budapest, Hungary
- Department of Radiology, Duna Medical Center, GE-RAD Kft, Budapest, Hungary
| | - Rossano Girometti
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Steven E Harms
- Breast Center of Northwest Arkansas, Fayetteville, AR, USA
| | - Sarah Hilborne
- Department of Radiology, School of Clinical Medicine, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Raffaele Ienzi
- Department of Radiology, Di.Bi.MED, Policlinico Universitario Paolo Giaccone Università degli Studi di Palermo, Palermo, Italy
| | - Marc B I Lobbes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Claudio Losio
- Department of Breast Radiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Stefania Montemezzi
- Department of Radiology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Inge-Marie Obdeijn
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Umit Aksoy Ozcan
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Federica Pediconi
- Department of Radiological, Oncological and Pathological Sciences, Università degli Studi di Roma "La Sapienza", Rome, Italy
| | - Katja Pinker
- Division of General and Paediatric Radiology, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Heike Preibsch
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Tübingen, Germany
| | | | | | - Daniela Sacchetto
- Kiwifarm S.R.L., La Morra, Italy
- Disaster Medicine Service 118, ASL CN1, Levaldigi, Italy
| | | | - Margrethe Schlooz
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Botond K Szabó
- Department of Radiology, Barking Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Donna B Taylor
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
- Department of Radiology, Royal Perth Hospital, Perth, Australia
| | - Sila Ö Ulus
- Department of Radiology, Acıbadem Atasehir Hospital, Istanbul, Turkey
| | - Mireille Van Goethem
- Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Department of Radiology, Multidisciplinary Breast Clinic, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jeroen Veltman
- Maatschap Radiologie Oost-Nederland, Oldenzaal, The Netherlands
| | - Stefanie Weigel
- Clinic for Radiology and Reference Center for Mammography, University of Münster, Münster, Germany
| | - Evelyn Wenkel
- Department of Radiology, University Hospital of Erlangen, Erlangen, Germany
| | - Chiara Zuiani
- Institute of Radiology, Department of Medicine, Ospedale Universitario S. Maria della Misericordia, Università degli Studi di Udine, Udine, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097, San Donato Milanese, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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191
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Poenariu IS, Boldeanu L, Ungureanu BS, Caragea DC, Cristea OM, Pădureanu V, Siloși I, Ungureanu AM, Statie RC, Ciobanu AE, Gheonea DI, Osiac E, Boldeanu MV. Interrelation of Hypoxia-Inducible Factor-1 Alpha (HIF-1 α) and the Ratio between the Mean Corpuscular Volume/Lymphocytes (MCVL) and the Cumulative Inflammatory Index (IIC) in Ulcerative Colitis. Biomedicines 2023; 11:3137. [PMID: 38137357 PMCID: PMC10741094 DOI: 10.3390/biomedicines11123137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
We intended to investigate the presence and medical application of serum hypoxia-inducible factor-1 alpha (HIF-1α) along with the already known systemic inflammatory markers and the new one's inflammatory indices, the proportion of mean corpuscular volume and lymphocytes (MCVL) and the cumulative inflammatory index (IIC), for patients with ulcerative colitis (UC). We sought to establish correlations that may be present between the serum levels of HIF-1α and these inflammatory indices, as well as their relationship with disease activity and the extent of UC, which can provide us with a more precise understanding of the evolution, prognosis, and future well-being of patients. Serum samples were collected from 46 patients diagnosed with UC and 23 controls. For our assessment of the serum levels of HIF-1α, we used the Enzyme-Linked Immunosorbent Assay (ELISA) technique. Thus, for HIF-1α we detected significantly higher values in more severe and more extensive UC. When it came to MCVL and IIC, we observed statistically significant differences between the three groups being compared (Severe, Moderate, and Mild). Our study highlighted that HIF-1α correlated much better with a disease activity score, MCVL, and IIC. With MCVL and IIC, a strong and very strong correlation had formed between them and well-known inflammation indices. By examining the ROC curves of the analyzed parameters, we recognized that TWI (accuracy of 83.70%) provides the best discrimination of patients with early forms of UC, followed by HIF-1α (73.90% accuracy), MCVL (70.90% accuracy), and PLR (70.40%). In our study, we observed that HIF-1α, MCVL, and PLR had the same sensitivity (73.33%) but HIF-1α had a much better specificity (60.87% vs. 58.70%, and 54.35%). Also, in addition to the PLR, HIF-1α and MCVL can be used as independent predictor factors in the discrimination of patients with early forms of UC.
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Affiliation(s)
- Ioan Sabin Poenariu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.S.P.); (R.-C.S.); (A.E.C.)
- Department of Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.S.); (M.V.B.)
| | - Lidia Boldeanu
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (O.M.C.); (A.M.U.)
| | - Bogdan Silviu Ungureanu
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (B.S.U.); (D.I.G.)
| | - Daniel Cosmin Caragea
- Department of Nephrology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Oana Mariana Cristea
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (O.M.C.); (A.M.U.)
| | - Vlad Pădureanu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Isabela Siloși
- Department of Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.S.); (M.V.B.)
| | - Anca Marinela Ungureanu
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (O.M.C.); (A.M.U.)
| | - Răzvan-Cristian Statie
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.S.P.); (R.-C.S.); (A.E.C.)
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (B.S.U.); (D.I.G.)
| | - Alina Elena Ciobanu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.S.P.); (R.-C.S.); (A.E.C.)
| | - Dan Ionuț Gheonea
- Department of Gastroenterology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (B.S.U.); (D.I.G.)
| | - Eugen Osiac
- Department of Biophysics, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Mihail Virgil Boldeanu
- Department of Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.S.); (M.V.B.)
- Medico Science SRL—Stem Cell Bank Unit, 200690 Craiova, Romania
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192
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Rohatgi N. JMIR Perioperative Medicine: A Global Journal for Publishing Interdisciplinary Innovations, Research, and Perspectives. JMIR Perioper Med 2023; 6:e54344. [PMID: 37988142 DOI: 10.2196/54344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
JMIR Perioperative Medicine supports the dissemination of technological and data science-driven innovative research conducted by interdisciplinary teams in perioperative medicine. We invite contributions on a broad range of topics from clinicians, scientists, and allied health professionals from across the globe.
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Affiliation(s)
- Nidhi Rohatgi
- Stanford University School of Medicine, Stanford, CA, United States
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Mika AP, Wollenman C, Steinle AM, Chanbour H, Vaughan W, Croft A, Lugo-Pico J, Zuckerman SL, Abtahi AM, Stephens BF. The Impact of the COVID-19 Pandemic on the Presentation of Patients With Spinal Metastases. Spine (Phila Pa 1976) 2023; 48:1599-1605. [PMID: 36255355 DOI: 10.1097/brs.0000000000004512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/08/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The aim was to determine if preoperative spinal instability neoplastic scores (SINSs) and Tokuhashi prognostication scores differed in patients receiving surgical care before and during the coronavirus disease-2019 (COVID-19) pandemic. SUMMARY OF BACKGROUND DATA The COVID-19 pandemic has caused delays in scheduling nonemergent surgeries. Delay in presentation and/or surgical treatment for oncology patients with metastatic spinal disease could result in progression of the disease, which can complicate surgical care and worsen patient outcomes. MATERIALS AND METHODS Retrospective review of electronic medical records between March 1, 2019 and March 1, 2021 at a tertiary medical center was performed to identify patients who underwent surgery for metastatic spine disease. Primary spinal tumors were excluded. Patients were separated into two groups base on their surgery date: before the COVID-19 pandemic (March 1, 2019-February 29, 2020) and during the COVID-19 pandemic (March 1, 2020-March 1, 2021). Primary outcomes included SINS and Tokuhashi scores. A variety of statistical tests were performed to compare the groups. RESULTS Fifty-two patients who underwent surgery before the COVID-19 pandemic were compared to 41 patients who underwent surgery during the COVID-19 pandemic. There was a significant difference between the before and during groups with respect to SINS (9.31±2.39 vs . 11.00±2.74, P =0.002) and Tokuhashi scores (9.27±2.35 vs . 7.88±2.85, P =0.012). Linear regression demonstrated time of surgery (before or during COVID-19 restrictions) was a significant predictor of SINS (β=1.55, 95% CI: 0.42-2.62, P =0.005) and Tokuhashi scores (β=-1.41, 95% CI: -2.49 to -0.34, P =0.010). CONCLUSIONS Patients with metastatic spinal disease who underwent surgery during the COVID-19 pandemic had higher SINS, lower Tokuhashi scores and similar Skeletal Oncology Research Group scores compared to patients who underwent surgery before the pandemic. This suggests the pandemic has impacted the instability of disease at presentation in patients with spinal metastases, but has not impacted surgical prognosis, as there were no differences in Skeletal Oncology Research Group scores and the difference in Tokuhashi scores is most likely not clinically significant.
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Affiliation(s)
- Aleksander P Mika
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Colby Wollenman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Anthony M Steinle
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Wilson Vaughan
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Andrew Croft
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Julian Lugo-Pico
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Scott L Zuckerman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Amir M Abtahi
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
| | - Byron F Stephens
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN
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Markovic M, Ranin J, Bukumiric Z, Jerotic D, Savic-Radojevic A, Pljesa-Ercegovac M, Djukic T, Ercegovac M, Asanin M, Milosevic I, Stevanovic G, Simic T, Coric V, Matic M. GPX3 Variant Genotype Affects the Risk of Developing Severe Forms of COVID-19. Int J Mol Sci 2023; 24:16151. [PMID: 38003341 PMCID: PMC10671662 DOI: 10.3390/ijms242216151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023] Open
Abstract
In SARS-CoV-2 infection, excessive activation of the immune system intensively increases reactive oxygen species levels, causing harmful hyperinflammatory and oxidative state cumulative effects which may contribute to COVID-19 severity. Therefore, we assumed that antioxidant genetic profile, independently and complemented with laboratory markers, modulates COVID-19 severity. The study included 265 COVID-19 patients. Polymorphism of GSTM1, GSTT1, Nrf2 rs6721961, GSTM3 rs1332018, GPX3 rs8177412, GSTP1 rs1695, GSTO1 rs4925, GSTO2 rs156697, SOD2 rs4880 and GPX1 rs1050450 genes was determined with appropriate PCR-based methods. Inflammation (interleukin-6, CRP, fibrinogen, ferritin) and organ damage (urea, creatinine, transaminases and LDH) markers, complete blood count and coagulation status (d-dimer, fibrinogen) were measured. We found significant association for COVID-19 progression for patients with lymphocytes below 1.0 × 109/L (OR = 2.97, p = 0.002). Increased IL-6 and CRP were also associated with disease progression (OR = 8.52, p = 0.001, and OR = 10.97, p < 0.001, respectively), as well as elevated plasma AST and LDH (OR = 2.25, p = 0.021, and OR = 4.76, p < 0.001, respectively). Of all the examined polymorphisms, we found significant association with the risk of developing severe forms of COVID-19 for GPX3 rs8177412 variant genotype (OR = 2.42, p = 0.032). This finding could be of particular importance in the future, complementing other diagnostic tools for prediction of COVID-19 disease course.
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Affiliation(s)
- Marko Markovic
- Clinic of Infectious and Tropical Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (J.R.); (I.M.); (G.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
| | - Jovan Ranin
- Clinic of Infectious and Tropical Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (J.R.); (I.M.); (G.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
| | - Zoran Bukumiric
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical Statistics and Informatics, 11000 Belgrade, Serbia
| | - Djurdja Jerotic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Centre for Excellence for Redox Medicine, Pasterova 2, 11000 Belgrade, Serbia
| | - Ana Savic-Radojevic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Centre for Excellence for Redox Medicine, Pasterova 2, 11000 Belgrade, Serbia
| | - Marija Pljesa-Ercegovac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Centre for Excellence for Redox Medicine, Pasterova 2, 11000 Belgrade, Serbia
| | - Tatjana Djukic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Centre for Excellence for Redox Medicine, Pasterova 2, 11000 Belgrade, Serbia
| | - Marko Ercegovac
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Clinic of Neurology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Milika Asanin
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Clinic of Cardiology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ivana Milosevic
- Clinic of Infectious and Tropical Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (J.R.); (I.M.); (G.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
| | - Goran Stevanovic
- Clinic of Infectious and Tropical Diseases, University Clinical Centre of Serbia, 11000 Belgrade, Serbia; (M.M.); (J.R.); (I.M.); (G.S.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
| | - Tatjana Simic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Centre for Excellence for Redox Medicine, Pasterova 2, 11000 Belgrade, Serbia
- Department of Medical Sciences, Serbian Academy of Sciences and Arts, 11000 Belgrade, Serbia
| | - Vesna Coric
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Centre for Excellence for Redox Medicine, Pasterova 2, 11000 Belgrade, Serbia
| | - Marija Matic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (Z.B.); (D.J.); (A.S.-R.); (M.P.-E.); (T.D.); (M.E.); (M.A.); (T.S.)
- Institute of Medical and Clinical Biochemistry, 11000 Belgrade, Serbia
- Centre for Excellence for Redox Medicine, Pasterova 2, 11000 Belgrade, Serbia
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Plotti F, Silvagni A, Montera R, De Cicco Nardone C, Luvero D, Ficarola F, Cundari GB, Branda F, Angioli R, Terranova C. Impact of COVID-19 Pandemic on the Diagnostic and Therapeutic Management of Endometrial Cancer: A Monocentric Retrospective Comparative Study. J Clin Med 2023; 12:7016. [PMID: 38002630 PMCID: PMC10671930 DOI: 10.3390/jcm12227016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Endometrial cancer represents an ideal target to evaluate the impact of COVID-19 being the most frequent gynecological malignancy in Italy, generally detected at early stages and correlated with favorable oncological outcomes. The present comparative retrospective study carried out at Campus Bio-medico University Foundation in Rome aims to evaluate the impact of the COVID-19 pandemic on the presentation, diagnosis and treatment of EC. All women with a histological diagnosis of non-endometrioid and endometrioid endometrial cancer between 1 March 2018 and 31 October 2022 were included. The number of cases was higher in period 2 (95 vs. 64 cases). Time to diagnosis did not show statistically significant differences but in period 2, 92.06% of the diagnoses were made following abnormal uterine bleeding, while in period 1, only 67.02% were. The waiting time for the intervention was significantly shorter in period 2. Definitive histology, FIGO staging, surgical technique and adjuvant therapy did not show significant differences between the two periods. The study demonstrates that the impact of the COVID-19 pandemic did not have a direct effect on the diagnostic delay, tumor staging and type of therapy but rather on the presentation pattern of endometrial cancer.
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Affiliation(s)
- Francesco Plotti
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Adele Silvagni
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Roberto Montera
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Carlo De Cicco Nardone
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Daniela Luvero
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Fernando Ficarola
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Gianna Barbara Cundari
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Francesco Branda
- Unit of Medical Statistics and Molecular Epidemiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Roberto Angioli
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Corrado Terranova
- Unit of Gynecology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
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196
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Ravenel M, Joliat GR, Demartines N, Uldry E, Melloul E, Labgaa I. Machine learning to predict postoperative complications after digestive surgery: a scoping review. Br J Surg 2023; 110:1646-1649. [PMID: 37478369 PMCID: PMC10638531 DOI: 10.1093/bjs/znad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Maximilien Ravenel
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Gaëtan-Romain Joliat
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Graduate School of Health Sciences, University of Bern, Bern, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Emmanuel Melloul
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Ismail Labgaa
- Department of Visceral Surgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
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197
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Farhat F, Sohail SS, Alam MT, Ubaid S, Shakil, Ashhad M, Madsen DØ. COVID-19 and beyond: leveraging artificial intelligence for enhanced outbreak control. Front Artif Intell 2023; 6:1266560. [PMID: 38028660 PMCID: PMC10663297 DOI: 10.3389/frai.2023.1266560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
COVID-19 has brought significant changes to our political, social, and technological landscape. This paper explores the emergence and global spread of the disease and focuses on the role of Artificial Intelligence (AI) in containing its transmission. To the best of our knowledge, there has been no scientific presentation of the early pictorial representation of the disease's spread. Additionally, we outline various domains where AI has made a significant impact during the pandemic. Our methodology involves searching relevant articles on COVID-19 and AI in leading databases such as PubMed and Scopus to identify the ways AI has addressed pandemic-related challenges and its potential for further assistance. While research suggests that AI has not fully realized its potential against COVID-19, likely due to data quality and diversity limitations, we review and identify key areas where AI has been crucial in preparing the fight against any sudden outbreak of the pandemic. We also propose ways to maximize the utilization of AI's capabilities in this regard.
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Affiliation(s)
- Faiza Farhat
- Department of Zoology, Aligarh Muslim University, Aligarh, India
| | | | - Mohammed Talha Alam
- Department of Computer Science and Engineering, Jamia Hamdard, New Delhi, India
| | - Syed Ubaid
- Faculty of Electronic and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - Shakil
- Faculty of Electronic and Information Technology, Warsaw University of Technology, Warsaw, Poland
| | - Mohd Ashhad
- Department of Computer Science and Engineering, Jamia Hamdard, New Delhi, India
| | - Dag Øivind Madsen
- USN School of Business, University of South-Eastern Norway, Hønefoss, Norway
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198
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Fancellu A, Maiore M, Grasso L, Ferrara M, Porcu A. Retroaortic left renal vein associated to variations of liver vasculature and biliary system in a patient submitted to total pancreatectomy. Hepatobiliary Pancreat Dis Int 2023:S1499-3872(23)00206-0. [PMID: 37968191 DOI: 10.1016/j.hbpd.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 11/02/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Alessandro Fancellu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy.
| | - Mario Maiore
- Department of Medicine, Surgery and Pharmacy, Unit of Radiology, University of Sassari, Sassari 07100, Italy
| | - Lavinia Grasso
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Miriam Ferrara
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
| | - Alberto Porcu
- Department of Medicine, Surgery and Pharmacy, Unit of General Surgery 2 - Clinica Chirurgica, University of Sassari, Sassari 07100, Italy
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199
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Thomas MB, Carmichael H, Harrison M, Abbitt D, Moore A, Myers QWO, Velopulos CG. Prioritizing rapid COVID-19 testing in emergency general surgery patients decreases burden of inpatient hospital admission. Trauma Surg Acute Care Open 2023; 8:e001085. [PMID: 37954921 PMCID: PMC10632905 DOI: 10.1136/tsaco-2023-001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023] Open
Abstract
Objectives The COVID-19 pandemic has changed delivery of emergency general surgery (EGS) and contributed to widespread bed shortages. At our institution, rapid testing is not routinely approved for EGS patients. We examined common EGS conditions (appendicitis and acute cholecystitis), hypothesizing that necessity of testing for COVID-19 significantly delayed operative intervention. Methods We performed a prepost study to examine a 2-month timeframe, or historical control, prior to COVID-19 testing (January 1, 2020-March 1, 2020) as well as a 2-month timeframe during the COVID-19 era (January 1, 2021-March 1, 2021). We chose conditions that are frequently treated surgically as outpatient or observation status. We examined time for COVID-19 test to result, and associated time to operative intervention (operating room (OR)) and need for admission. Results Median time to COVID-19 test results was 7.4 hours (IQR 5.8-13.1). For appendectomy, time to surgical consultation or case request did not differ between cohorts. Time to OR after case request was significantly longer (12.5 vs 1.9 hours, p<0.001) and patients more frequently required admission prior to operative intervention if receiving treatment in the COVID-19 timeframe. Similarly, for cholecystectomy there were no differences in time to surgical consultation or case request, but time to OR after case request was longer in the COVID-19 era (21.1 vs 9.0 hours, p<0.001). Conclusion While COVID-19 positivity rates have declined, the purpose of this study was to reflect on one element of our hospital system's response to the COVID-19 pandemic. Based on our institutional experience, waiting for COVID-19 test results directly impacts time to surgery, as well as the need for admission for a historically outpatient procedure. In the future, if the healthcare system is asked to respond to another pandemic or similar situation, expediting time to OR to eliminate unnecessary time in the hospital and non-critical admissions should be paramount. Level of evidence Level III, prognostic/epidemiological.
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Affiliation(s)
- Madeline B Thomas
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Heather Carmichael
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Madison Harrison
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Danielle Abbitt
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Allison Moore
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Quintin W O Myers
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Catherine G Velopulos
- Department of Surgery, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
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200
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Manzia TM, Sensi B, Conte LE, Siragusa L, Angelico R, Frongillo F, Tisone G. Evaluation of Humoral Response following SARS-CoV-2 mRNA-Based Vaccination in Liver Transplant Recipients Receiving Tailored Immunosuppressive Therapy. J Clin Med 2023; 12:6913. [PMID: 37959382 PMCID: PMC10650358 DOI: 10.3390/jcm12216913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/24/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
Background: The role of tailored immunosuppression (IS) in the development of the humoral response (HR) to SARS-CoV-2 mRNA-based vaccination in liver transplant (LT) recipients is unknown. Methods: This is a single-centre prospective study of patients who underwent LT between January 2015 and December 2021 and who have received three doses of mRNA-based SARS-CoV-2 vaccination. Patients undergoing Tacrolimus-based immunosuppression (TAC-IS) were compared with those undergoing Everolimus-based immunosuppression (EVR-IS). Patients receiving the TAC-EVR combination were divided into two groups based on trough TAC concentrations, i.e., above or below 5 ng/mL. HR (analysed with ECLIA) was assessed at 30 to 135 days after vaccination. The primary outcome was the presence of a positive antibody titre (≥0.8 U/mL). Secondary outcomes were the presence of a highly protective antibody titre (≥142 U/mL), median antibody titre, and incidence of COVID-19. Results: Sixty-one participants were included. Twenty-four (40%) were receiving TAC-IS and thirty-seven (60%) were receiving EVR-IS. At the median follow-up of 116 (range: 89-154) days, there were no significant differences in positive antibody titre (95.8% vs. 94.6%; p = 0.8269), highly-protective antibody titre (83.3% vs. 81.1%; p = 0.8231), median antibody titre (2410 [IQ range 350-2500] vs. 1670 [IQ range 380-2500]; p = 0.9450), and COVID-19 incidence (0% vs. 5.4%; p = 0.5148). High serum creatinine and low estimated glomerular filtration rate were risk factors for a weak or absent HR. Conclusions: Three doses of mRNA-based SARS-CoV-2 vaccination yielded a highly protective HR in LT recipients. The use of TAC or EVR-based IS does not appear to influence HR or antibody titre, while renal disease is a risk factor for a weak or null HR.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Surgical Science, Università degli Studi di Roma “Tor Vergata”, 00133 Rome, Italy (B.S.)
| | - Bruno Sensi
- Department of Surgical Science, Università degli Studi di Roma “Tor Vergata”, 00133 Rome, Italy (B.S.)
| | - Luigi Eduardo Conte
- Department of Surgical Science, Università degli Studi di Roma “Tor Vergata”, 00133 Rome, Italy (B.S.)
| | - Leandro Siragusa
- Department of Surgical Science, Università degli Studi di Roma “Tor Vergata”, 00133 Rome, Italy (B.S.)
| | - Roberta Angelico
- Department of Surgical Science, Università degli Studi di Roma “Tor Vergata”, 00133 Rome, Italy (B.S.)
| | - Francesco Frongillo
- Department of Surgery-Transplantation Service, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giuseppe Tisone
- Department of Surgery-Transplantation Service, Catholic University of the Sacred Heart, 00168 Rome, Italy
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