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Chen KA, Gartner V, Darlington KC, Silverstein SR, Kennedy Ng MM, Butler L, Avalos K, Nishiyama NC, Joisa CU, Schaner MR, Lian G, Beasley C, Lau GW, Bauer MJ, Zhu LC, Kapadia MR, Gomez SM, Furey TS, Sheikh SZ. Post-operative Crohn's Disease Recurrence and Infectious Complications: A Transcriptomic Analysis. Dig Dis Sci 2024:10.1007/s10620-024-08595-3. [PMID: 39215865 DOI: 10.1007/s10620-024-08595-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic inflammatory condition affecting the gastrointestinal tract, characterized by complications such as strictures, fistulas, and neoplasia. Despite medical advancements, a significant number of patients with Crohn's disease require surgery, and many experience post-operative complications and recurrence. Previous studies have analyzed gene expression to study recurrence and post-operative complications independently. This study aims to identify overlapping differentially expressed genes and pathways for recurrence and post-operative complications. METHODS A dataset including 45 patients with Crohn's disease, including gene expression from ileum and colon tissue, endoscopic recurrence, and intra-abdominal septic complications was analyzed. Gene set enrichment analysis was used to identify gene pathways associated with the outcomes. Finally, a multi-variable logistic regression model was created to assess whether gene pathways were independently associated with both outcomes. RESULTS In ileum tissue, several inflammatory pathways, including interferon alpha and gamma response were upregulated in patients with endoscopic recurrence and intra-abdominal septic complications. In addition, there was upregulation of the epithelial mesenchymal transition pathway. In colon tissue, metabolic processes, such as myogenesis and oxidative phosphorylation were downregulated in both outcomes. In a multivariate model, downregulation of myogenesis in colon tissue was significantly associated with both endoscopic recurrence and intra-abdominal septic complications. CONCLUSION These findings shed light on the underlying biology of these outcomes and suggest potential biomarkers or therapeutic targets to reduce their occurrence. Further validation and multi-institutional studies are warranted to confirm these results and improve post-operative outcomes for patients with Crohn's disease.
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Affiliation(s)
- Kevin A Chen
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
- Department of Surgery, University of North Carolina at Chapel Hill, 100 Manning Drive, Burnett Womack Building, Suite 4038, Chapel Hill, NC, 27599, USA
| | - Valerie Gartner
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Kimberly C Darlington
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Sophie R Silverstein
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Meaghan M Kennedy Ng
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Logan Butler
- Department of Surgery, University of North Carolina at Chapel Hill, 100 Manning Drive, Burnett Womack Building, Suite 4038, Chapel Hill, NC, 27599, USA
| | - Kelli Avalos
- Department of Surgery, University of North Carolina at Chapel Hill, 100 Manning Drive, Burnett Womack Building, Suite 4038, Chapel Hill, NC, 27599, USA
| | - Nina C Nishiyama
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Chinmaya U Joisa
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, 10202C Mary Ellen Jones Building, Chapel Hill, NC, 27599, USA
| | - Matthew R Schaner
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Grace Lian
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Caroline Beasley
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Gwen W Lau
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Mikaela J Bauer
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
| | - Lee-Ching Zhu
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, CB #7525, Brinkhous-Bullitt Building, Chapel Hill, NC, 27599, USA
| | - Muneera R Kapadia
- Department of Surgery, University of North Carolina at Chapel Hill, 100 Manning Drive, Burnett Womack Building, Suite 4038, Chapel Hill, NC, 27599, USA
| | - Shawn M Gomez
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill, 10202C Mary Ellen Jones Building, Chapel Hill, NC, 27599, USA
| | - Terrence S Furey
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA.
- Department of Genetics, Curriculum in Bioinformatics and Computational Biology, University of North Carolina at Chapel Hill, 5000D Genetic Medicine Building, 120 Mason Farm Road, Chapel Hill, NC, CB #726427599, USA.
| | - Shehzad Z Sheikh
- Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Bioinformatics Building; CB #7555, 130 Mason Farm Road, Chapel Hill, NC, 27599, USA
- University of North Carolina at Chapel Hill, 7314 Medical Biomolecular Research Building, 111 Mason Farm Road, Chapel Hill, NC, 27599, USA
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252
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Zhang M, Feng Q, Wang M. Impact of perioperative blood transfusion on elderly gastric cancer patients. J Gastrointest Oncol 2024; 15:2024-2025. [PMID: 39279921 PMCID: PMC11399879 DOI: 10.21037/jgo-24-416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/05/2024] [Indexed: 09/18/2024] Open
Affiliation(s)
- Mingyu Zhang
- Department of General Surgery, Dejiang County People's Hospital, Tongren, China
| | - Qingbo Feng
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Maijian Wang
- Department of General Surgery, Digestive Disease Hospital, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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253
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Lee SW, Kim M, Kim SH, Han DH, Choi GH, Kim KS, Choi JS, Park YN. Sarcomatoid change in combined hepatocellular carcinoma and cholangiocarcinoma as a poor prognostic factor. J Gastrointest Oncol 2024; 15:1796-1804. [PMID: 39279943 PMCID: PMC11399835 DOI: 10.21037/jgo-24-313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/09/2024] [Indexed: 09/18/2024] Open
Abstract
Background Sarcomatoid change is rarely seen in epithelial malignancy that can be observed in diverse organs. Although a sarcomatoid change in combined hepatocellular-cholangiocarcinoma (cHCC-CC) is assumed to be a poor prognostic factor, this issue has not been studied due to its rare incidence. In this study, we aimed to identify the oncological impact of sarcomatoid change in patients with cHCC-CC and verify that sarcomatoid change is a poor prognostic factor for resected cHCC-CC. Methods Between January 2006 and December 2020, 102 patients who underwent surgical resection for cHCC-CC were retrospectively reviewed. The hazard ratio (HR) according to sarcomatoid change was calculated using other known prognostic factors for cHCC-CC. In addition, the patients were divided into two groups according to the sarcomatoid change, and their survival was compared. Results The multivariate analysis demonstrated that sarcomatoid change in cHCC-CC is a poor prognostic factor {disease-free survival (DFS), HR =3.84 [95% confidence interval (CI): 1.63-9.10], P=0.002; overall survival (OS), HR =3.94 (95% CI: 1.67-9.31), P=0.002}. In the survival analysis, the sarcomatoid change group displayed a worse prognosis compared to the non-sarcomatoid change group {DFS: 4.0 [interquartile range (IQR): 1.2-6.8] vs. 23.0 (IQR: 9.3-36.7) months, P=0.001; OS: 19.0 (IQR: 7.2-30.8) vs. 85.0 (IQR: 31.8-138.2) months, P=0.004}. Conclusions Sarcomatoid change is a poor prognostic factor for resected cHCC-CC.
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Affiliation(s)
- Suk Won Lee
- Department of General Surgery, Severance Hospital, Seoul, Korea
| | - Milim Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hyun Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dai Hoon Han
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Nyun Park
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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254
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Lee O, Lee C, Yoon SK, Jeong J, Kim HC, Chung JC. Safety and efficacy of hepaticoduodenostomy for biliary reconstruction after extrahepatic mid-bile duct cancer surgery. Gland Surg 2024; 13:1418-1427. [PMID: 39282036 PMCID: PMC11398998 DOI: 10.21037/gs-24-155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 08/07/2024] [Indexed: 09/18/2024]
Abstract
Background Bile duct resection and reconstruction for bile duct cancer (BDC) is a complex surgical and oncologic procedure that requires extensive resection and reconstruction of the biliary tract. Hepaticojejunostomy is commonly performed for biliary reconstruction after extrahepatic mid-bile duct resection, while hepaticoduodenostomy (HD) is performed only rarely due to the risk of ascending cholangitis. However, the efficacy of HD has not been well-established in extrahepatic mid-BDC surgery. In this study, we aimed to analyze the outcomes of HD in patients who underwent bile duct resection for extrahepatic mid-BDC. Methods We retrospectively analyzed 38 extrahepatic mid-BDC patients who underwent bile duct resection in our center between January 2018 and June 2023. We compared postoperative outcomes, cancer recurrence, and patient survival between hepaticojejunostomy (n=20) and HD (n=18) groups. Results Operation time for the HD group was significantly shorter than that of the hepaticojejunostomy group (188 vs. 206 min, P=0.044) with no significant differences in postoperative outcomes. Regression analysis showed that a HD was not associated with a significantly high risk of cancer recurrence or decrease in patient survival. Conclusions HD appears to have comparable operative benefits, postoperative complications, and oncologic outcomes to hepaticojejunostomy in extrahepatic mid-BDC patients.
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Affiliation(s)
- Okjoo Lee
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Cheolgu Lee
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - So Kyung Yoon
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jaehong Jeong
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hyung Chul Kim
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jun Chul Chung
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
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255
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Wang Z, Li H, Tao H, Xie M, Wei S, Xiong Z. The impact of transanal drainage tube on the incidence of anastomotic leakage and small bowel obstruction in radical surgery (Dixon) for rectal cancer: a retrospective cohort study. J Gastrointest Oncol 2024; 15:1508-1518. [PMID: 39279931 PMCID: PMC11399866 DOI: 10.21037/jgo-24-537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024] Open
Abstract
Background Anastomotic leakage (AL) and small bowel obstruction (SBO) are common complications after rectal cancer radical surgery (Dixon). Although the commonly used defunctioning stoma (DS) can reduce the incidence and harm of AL, it increases the probability of other adverse consequences, including SBO. Therefore, a safe and effective method for preventing the complications related to the radical surgery of rectal cancer is urgently needed. Previous studies have found that transanal drainage tube (TDT) can have a positive impact on the incidence of these two complications by draining gas and feces from the intestinal lumen, without causing other serious consequences. Therefore, this article further explores the clinical benefits that TDT can bring by analyzing the clinical data of postoperative patients with rectal cancer. Methods This study included 221 patients who underwent radical surgery (Dixon) for rectal cancer in Hubei Cancer Hospital from September 2020 to February 2023, determine whether it meets the inclusion criteria of this study based on preoperative examination, intraoperative exploration results, and treatment methods. DS was used in 70 patients and TDT in 88 patients during the surgery; meanwhile, no protective anastomotic measures were applied in 63 patients. Seventy patients subjected to DS were categorized as group 1, 88 patients subjected to TDT as group 2, and 63 patients with no protective measures for anastomosis as group 3. Through postoperative clinical manifestations, imaging examinations, and laboratory tests, a total of 18 cases of AL and 30 cases of SBO were identified in the three groups. The effectiveness of TDT and that of other surgical procedures in preventing complications, accelerating postoperative recovery, and reducing surgical costs were compared through univariate and multivariate analyses. Results The clinical features of the three groups have baseline comparability. No statistically difference was noted in baseline characteristics between three groups (all P>0.05). The incidence of AL and SBO in group 1 are 7.1% and 27.1%, in group 2 are 3.4% and 4.5%, and in group 3 are 15.9% and 11.1%. Compared to patients in no protective anastomotic measures with TDT and DS, TDT has a lower incidence of postoperative AL (P<0.05) and SBO (P>0.05), and faster postoperative recovery (P<0.05). The cost of inpatient surgery is not significantly different (P>0.05). Although DS can reduce the incidence of AL to a certain extent (P>0.05), it significantly increased the incidence of SBO (P<0.05), delayed postoperative defecation time (P<0.05) and caused higher cost (P<0.001). Compared to DS, the incidence of AL in TDT is not significantly different (P>0.05), but the incidence of SBO is noticeably lower (P<0.001), with faster postoperative recovery and less cost (P<0.05). Conclusions TDT is a safer, more effective, and more economical surgery for preventing postoperative complications.
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Affiliation(s)
- Zihao Wang
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Colorectal Cancer, Wuhan Clinical Research Center for Colorectal Cancer, Wuhan, China
| | - Huachi Li
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Colorectal Cancer, Wuhan Clinical Research Center for Colorectal Cancer, Wuhan, China
| | - Haoran Tao
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Colorectal Cancer, Wuhan Clinical Research Center for Colorectal Cancer, Wuhan, China
| | - Min Xie
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Colorectal Cancer, Wuhan Clinical Research Center for Colorectal Cancer, Wuhan, China
| | - Shaozhong Wei
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Colorectal Cancer, Wuhan Clinical Research Center for Colorectal Cancer, Wuhan, China
| | - Zhiguo Xiong
- Department of Gastrointestinal Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei Provincial Clinical Research Center for Colorectal Cancer, Wuhan Clinical Research Center for Colorectal Cancer, Wuhan, China
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256
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Haastrup PF, Hansen JM, Søndergaard J, Jarbøl DE. General practice variation in peptic ulcer prophylaxis: a nationwide register-based study. Scand J Prim Health Care 2024:1-9. [PMID: 39210714 DOI: 10.1080/02813432.2024.2396871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Incidence of peptic ulcer bleeding can be substantially reduced by prophylactic use of proton pump inhibitors (PPIs) in patients at risk, but use of PPI varies among risk patients, and substantial under-prescribing may exist. The variation in prophylactic prescribing among general practices remains unknown. METHODS A nationwide register-based cross-sectional study analyzing the proportion of patients at risk of ulcer bleeding receiving PPI treatment within Danish general practices. Using logistic regression, we analyze associations between general practice characteristics and prophylactic treatment among patients at risk of ulcer bleeding listed with the general practice. RESULTS In most general practices, less than 40% of the patients at increased risk of ulcer bleeding were covered by PPI. Geographical variation was present, where practice location outside the capital area was associated with higher odds of PPI coverage among their risk patients. Partnership practices with GPs with a mean age ≥65 years or with only female GPs were associated with higher odds of providing prophylaxis among their risk patients compared to practices with a mean GP age <45 years or with only male GPs. Similar associations were not found for single-handed practices. CONCLUSIONS A significant under-prescribing of ulcer prophylaxis is common across all general practice characteristics, and only few associations with practice characteristics were present. Most efforts to rationalize PPI prescribing have aimed at reducing overprescribing but the findings point to under-prescribing as a problem as well. Development of new methods to assist GPs in identifying individuals at risk of ulcer complications is needed.
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Affiliation(s)
- Peter Fentz Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jane Møller Hansen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Dorte Ejg Jarbøl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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257
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Dong X, Xiao B, Vu H, Lin H, Sitti M. Millimeter-scale soft capsules for sampling liquids in fluid-filled confined spaces. SCIENCE ADVANCES 2024; 10:eadp2758. [PMID: 39196937 PMCID: PMC11352903 DOI: 10.1126/sciadv.adp2758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/23/2024] [Indexed: 08/30/2024]
Abstract
Sampling liquids in small and confined spaces to retrieve chemicals and microbiomes could enable minimally invasive monitoring human physiological conditions for understanding disease development and allowing early screening. However, existing tools are either invasive or too large for sampling liquids in tortuous and narrow spaces. Here we report a fundamental liquid sampling mechanism that enables millimeter-scale soft capsules for sampling liquids in confined spaces. The miniature capsule is enabled by flexible magnetic valves and superabsorbent polymer, fully wirelessly controlled for on-demand fluid sampling. A group of miniature capsules could navigate in fluid-filled and confined spaces safely using a rolling locomotion. The integration of on-demand triggering, sampling, and sealing mechanism and the agile group locomotion allows us to demonstrate precise control of the soft capsules, navigating and sampling body fluids in a phantom and animal organ ex vivo, guided by ultrasound and x-ray medical imaging. The proposed mechanism and wirelessly controlled devices spur the next-generation technologies for minimally invasive disease diagnosis.
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Affiliation(s)
- Xiaoguang Dong
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
| | - Boyang Xiao
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Hieu Vu
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Honglu Lin
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Metin Sitti
- Physical Intelligence Department, Max Planck Institute for Intelligent Systems, 70569 Stuttgart, Germany
- School of Medicine and College of Engineering, Koç University, 34450 Istanbul, Turkey
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258
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Ren G, Yang L. The effect of TCM triple rehabilitation and ear acupoint bean pressing on laparoscopic surgery for gastric cancer. Medicine (Baltimore) 2024; 103:e39423. [PMID: 39213195 PMCID: PMC11365618 DOI: 10.1097/md.0000000000039423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
To explore the clinical value of the triple pre-rehabilitation nursing model in laparoscopic radical surgery for gastric cancer. Eighty-two gastric cancer patients admitted to a certain hospital from May 2020 to May 2023 are included in this study. Patients were divided into control group (CG) and treatment group according to different nursing methods. Comparisons were made by comparing perioperative indicators, immune indicators, sleep quality, nutritional indicators, and anxiety before and after patient care, as well as whether or not to utilize the acupoint patch combined with ear acupoint bean pressing burial in Chinese medicine care. Under the conditions of the triple pre-rehabilitation nursing model, the observation group (OG) patients had their first exhaust time, first bed activity time, first bowel movement time, and hospitalization time of 62.15 ± 5.93, 18.67 ± 7.55, 2.05 ± 0.58, and 7.21 ± 1.05, respectively. The postoperative values of ALB in the CG and OG were 31.59 ± 7.65 and 36.08 ± 8.27, respectively, while the postoperative values of prealbumin were 0.19 ± 0.05 and 0.27 ± 0.09, respectively. The sleep quality of the CG before nursing was 22.57 ± 3.66, and after nursing was 14.36 ± 3.72. The satisfaction rate of the OG was 56.10%, while that of the CG was 46.34%. Patients can better adapt to the treatment process, reduce anxiety, and improve the treatment effect and quality of life after the triple pre-rehabilitation nursing care model and acupoint paste combined with ear acupoint bean pressing burrowing in traditional Chinese medicine nursing.
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Affiliation(s)
- Guangzhuo Ren
- Department of Nursing, Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
| | - Liping Yang
- Department of Oncology, Baoji Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, China
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259
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Wang Y, Lei X, Shan F, Li S, Jia Y, Miao R, Xue K, Li Z, Ji J, Li Z. Long-term outcomes of laparoscopic versus open total gastrectomy in patients with advanced gastric cancer after neoadjuvant chemotherapy: a retrospective cohort study. BMC Cancer 2024; 24:1074. [PMID: 39215275 PMCID: PMC11365285 DOI: 10.1186/s12885-024-12669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study was conducted to investigate the long-term outcomes of laparoscopic total gastrectomy (LTG) versus open total gastrectomy (OTG) in patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NACT). METHODS Patients with AGC who received NACT before surgery were enrolled in either the LTG or OTG group. Propensity score matching (PSM) (1:2) was performed between the two groups based on the propensity score using a 0.15 calliper width. Three-year overall survival (OS) and disease-free survival (DFS) were compared between these two groups before and after PSM. OS and DFS rates were calculated by the Kaplan‒Meier method, and any differences in survival were evaluated with a log-rank test. Univariate and multivariate Cox proportional hazards analyses were used to estimate the simultaneous effects of prognostic factors on survival and the hazard ratio (HR) between LTG and OTG patients. RESULTS A total of 144 patients completed the follow-up, with 24 patients in the LTG group and 120 patients in the OTG group. After a mean follow-up of 64.40 months, there were no significant differences in the 3-year OS or DFS rates between the two groups before (P = 0.453 and P = 0.362, respectively) or after PSM (P = 0.972 and P = 0.884, respectively). Multivariate Cox proportional hazards analysis indicated that ypN stage was an independent risk factor for worse OS (P = 0.013). CONCLUSIONS This study showed that LTG with D2 lymphadenectomy performed by an experienced surgical team resulted in comparable 3-year OS and DFS compared with OTG in patients with AGC after NACT. TRIAL REGISTRATION This study is not registered.
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Affiliation(s)
- Yinkui Wang
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xiaokang Lei
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Fei Shan
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Shuangxi Li
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yongning Jia
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Rulin Miao
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Kan Xue
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhemin Li
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Jiafu Ji
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
- State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Ziyu Li
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China.
- Key Laboratory of Carcinogenesis and Translational Research, (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China.
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260
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Ruff SM, Chang JY, Xu M, Ejaz AM, Dillhoff M, Pawlik TM, Makary MS, Rikabi A, Sukrithan V, Konda B, Cloyd JM. Trans-arterial embolization versus chemoembolization for neuroendocrine liver metastases: a propensity matched analysis. HPB (Oxford) 2024:S1365-182X(24)02283-4. [PMID: 39271375 DOI: 10.1016/j.hpb.2024.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/16/2024] [Accepted: 08/29/2024] [Indexed: 09/15/2024]
Abstract
INTRODUCTION Locoregional therapies are a mainstay of treatment for patients with neuroendocrine liver metastases (NELM), yet the optimal transarterial approach remains undefined and recent studies have raised concern over the safety of transarterial chemoembolization (TACE). METHODS Patients with NELM who underwent TACE or transarterial embolization (TAE) at a single institution between 2000-2022 were retrospectively reviewed. Propensity score matching (PSM) controlling for age, sex, bilateral disease, tumor size, lobar embolization, grade, and extrahepatic disease was utilized to compare short- and long-term outcomes. RESULTS Among 412 patients with NELM, 329 underwent TACE and 83 TAE. Mean age was 60.7 ± 11.1 years. Patients primarily presented with synchronous (69.2%), bilateral (84.2%), and G1 disease (48.8%) and underwent staged procedures (55.8%). Following PSM, TACE was associated with slightly worse post-procedure laboratory values, but no difference in complications compared to TAE (23.3%vs29.3%, p = 0.247). TACE was associated with improved mean PFS (21.8vs10.7 months, p = 0.002), but no difference in radiographic size, chromogranin level, or median overall survival (50.0 months vs not met, p = 0.833). CONCLUSION Among patients with NELM, TACE was associated with similar short-term outcomes and improved PFS, but no difference in OS compared to TAE. These findings highlight the need for additional research on the optimal locoregional therapy for NELM.
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Affiliation(s)
- Samantha M Ruff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Jin Y Chang
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Menglin Xu
- Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Aslam M Ejaz
- Department of Surgery, Division of Surgical Oncology, University of Illinois, Chicago, IL 60612, USA
| | - Mary Dillhoff
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Mina S Makary
- Department of Interventional Radiology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Ali Rikabi
- Department of Interventional Radiology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Vineeth Sukrithan
- Department of Medical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Bhavana Konda
- Department of Medical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH 43210, USA.
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261
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Comes DJ, Bluiminck S, Kooistra EJ, de Nes L, van Workum FTWE, Touw H, Eussen MMM, Bouvy ND, Stobernack T, de Reuver PR. The carbon footprint of a laparoscopic cholecystectomy. Br J Surg 2024; 111:znae225. [PMID: 39291674 PMCID: PMC11408924 DOI: 10.1093/bjs/znae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 08/16/2024] [Accepted: 08/18/2024] [Indexed: 09/19/2024]
Abstract
Lay Summary
Background
Gallbladder removal is one of the most common surgical procedures worldwide. The keyhole operation treats patients with symptomatic gallstones. This procedure uses many single-use tools and results in a lot of waste. Before we can make this operation more sustainable, we need to assess the amount of waste and CO2 emissions.
Aim
The aim of this study was to identify the types of waste and measure the CO2 emissions created by a gallbladder removal.
Method
We collected waste from 15 gallbladder operations at three hospitals. We noted the medications used and measured the surgery duration to estimate electricity consumption. We also asked all the staff how they travelled to the hospital that day.
Findings and Conclusion
The operation produces about 56.5 kg of CO2. The main sources of CO2 are single-use tools, packaging materials and disposable drapes and gowns. This study helps us understand where most CO2 is produced, so we can work on reducing it more effectively.
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Affiliation(s)
- Daan J Comes
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Stijn Bluiminck
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Emma J Kooistra
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lindsey de Nes
- Department of Surgery, Maasziekenhuis Pantein, Boxmeer, The Netherlands
| | | | - Hugo Touw
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Myrthe M M Eussen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Tim Stobernack
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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262
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Winfield FJ, Nasim S. Adult ileocaecal intussusception caused by lipoma managed in a remote Western Australian hospital. BMJ Case Rep 2024; 17:e259963. [PMID: 39209749 DOI: 10.1136/bcr-2024-259963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Intussusception is rare in adults, making it a challenging and often delayed diagnosis. Patients may re-present with non-specific and subacute abdominal symptoms. Abdominal CT is the most sensitive imaging modality and is often required to make the diagnosis of intussusception. In contrast to the paediatric population, intussusception in adults is most often associated with a pathological lesion acting as a lead point. In adults, the lead point is often secondary to malignancy, though benign lesions can also be implicated. As such, surgical management with selective resection is the mainstay of treatment in adults. We describe a rare case of ileocaecal intussusception in an adult secondary to a large ileocaecal lipoma, successfully treated with laparotomy and resection in a remote Western Australian hospital. The increasing availability of CT imaging and skilled general surgeons in rural and remote Australia allows for the diagnosis and surgical management of such cases without inter-hospital transfer.
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Affiliation(s)
| | - Sana Nasim
- Surgery, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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263
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Zouari M, Belhajmansour M, Jarboui O, Ben Kraiem N, Ben Dhaou M. Can Ultrasound Reliably Detect Complicated Appendicitis in Pediatric Patients? J Pediatr Surg 2024:161885. [PMID: 39299862 DOI: 10.1016/j.jpedsurg.2024.161885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/25/2024] [Indexed: 09/22/2024]
Affiliation(s)
- Mohamed Zouari
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia; Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia.
| | - Manel Belhajmansour
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia; Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Oumaima Jarboui
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia; Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
| | - Najoua Ben Kraiem
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Research Laboratory "Developmental and Induced Diseases" (LR19ES12), Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia; Department of Pediatric Surgery, Hedi Chaker Hospital, 3029 Sfax, Tunisia
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264
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Yin H, Romero-Hernandez F, Ganjouei AA, Wang JJ, Brown A, Hirose K, Maker AV, Nakakura E, Corvera C, Kirkwood KS, Wilhelm A, Peng JS, Alseidi A, Adam MA. Adult Pancreatoblastoma: Clinical Insights and Outcomes Compared to Pancreatic Ductal Adenocarcinoma (PDAC). Curr Oncol 2024; 31:5008-5020. [PMID: 39329998 PMCID: PMC11430823 DOI: 10.3390/curroncol31090370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/28/2024] Open
Abstract
Pancreatoblastoma is perceived to be aggressive in adults; however, data are limited due to the rarity of the disease. We benchmarked clinico-pathologic characteristics, outcomes, and survival of adult patients with pancreatoblastoma to a comparable PDAC cohort using the National Cancer Database (NCDB). This study included 301,204 patients: 35 with pancreatoblastoma and 301,169 PDAC patients. Pancreatoblastoma patients were younger than PDAC patients (56 vs. 69 years, p < 0.001). More pancreatoblastoma patients were managed at academic institutions (63.0% vs. 40.7%, p = 0.047). The most frequent primary site was the head and the neck of the pancreas. There were no differences in tumor size (4.2 cm vs. 3.7 cm, p = 0.828), lymph node positivity (14.3% vs. 26.4%, p = 0.103), or metastasis at time of diagnosis (31.4% vs. 46.1%, p = 0.081). The majority of pancreatoblastoma patients underwent resection compared to a minority of PDAC patients (69.7% vs. 15.5%, p < 0.001). Time from diagnosis to surgery was longer for pancreatoblastoma patients (33 vs. 14 days, p = 0.030). Pancreaticoduodenectomy was the most common type of resection in the pancreatoblastoma and PDAC groups (47.8% vs. 67.7%, p = 0.124). Among resected patients, pancreatoblastoma patients were less likely to receive radiation (4.8% vs. 37.0%, p = 0.002), but the use of chemotherapy was similar to PDAC patients (60.9% vs. 70.7%). After matching, median overall survival was longer for pancreatoblastoma than PDAC (59.8 months vs. 15.2 months, p = 0.014).
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Affiliation(s)
- Han Yin
- School of Medicine, University of California, San Francisco, CA 94143, USA;
| | | | - Amir Ashraf Ganjouei
- Department of Surgery, University of California, San Francisco, CA 94143, USA; (F.R.-H.)
| | - Jaeyun Jane Wang
- Department of Surgery, University of California, San Francisco, CA 94143, USA; (F.R.-H.)
| | - Audrey Brown
- Department of Surgery, University of California, San Francisco, CA 94143, USA; (F.R.-H.)
| | - Kenzo Hirose
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
| | - Ajay V. Maker
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
| | - Eric Nakakura
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
| | - Carlos Corvera
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
| | - Kimberly S. Kirkwood
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
| | - Alexander Wilhelm
- Department of Visceral Surgery, Clarunis—University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4058 Basel, Switzerland
| | - June S. Peng
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
| | - Adnan Alseidi
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
| | - Mohamed A. Adam
- Department of Surgery, Division of Surgical Oncology, University of California, San Francisco, CA 94143, USA (C.C.)
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265
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Choi B, Church J, Khoshknabi D, Jabi O, Kiran RP. Outcomes after right-sided colon surgery in Crohn's disease versus cancer. Tech Coloproctol 2024; 28:116. [PMID: 39198315 DOI: 10.1007/s10151-024-02962-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/08/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND Surgery for Crohn's disease (CD) is considered to have more complications due to the underlying inflammation, immunosuppression, and malnutrition. We sought to study the outcomes of right-sided colonic resection in patients with CD and patients with cancer at a high-volume tertiary center utilizing a standardized perioperative protocol. METHODS This is a retrospective study of outcomes for all patients with CD or patients undergoing ileocolic resection or right hemicolectomy with ileocolic anastomosis at a single institution from 2013 to 2022. Patients were excluded if they simultaneously underwent another procedure or ostomy creation. Data were analyzed using Wilcoxon rank-sum and chi-squared tests for univariate analyses, and logistic and linear regressions for multivariate analyses. RESULTS In total 141 patients with CD and 589 patients with cancer were included. Patients with CD were significantly younger with lower body mass index and less likely to have comorbidities, including diabetes and hypertension. Patients with CD were less likely to have a smoking history or prior abdominal surgery, but more likely to be on steroids. Both groups had similar rates of laparoscopy, intraoperative complications, and blood loss. Despite the preoperative and intraoperative differences, both patients with CD and patients with cancer had similar lengths of stay (LOS), readmission, reoperation, and mortality rates. None of the surgical outcomes differed significantly between the two groups. On multivariate analysis, CD diagnosis was not associated with reoperation, readmission, mortality, or LOS while controlling for other characteristics. CONCLUSIONS With the use of standardized perioperative protocols, surgery for CD at a high-volume center with expertise in CD can be performed with comparable results to other indications like cancer.
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Affiliation(s)
- B Choi
- The Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA.
| | - J Church
- The Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA
| | - D Khoshknabi
- The Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA
| | - O Jabi
- The Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA
| | - R P Kiran
- The Global Center for Integrated Colorectal Surgery and IBD Interventional Endoscopy, Columbia University Irving Medical Center/New York Presbyterian Hospital, 161 Fort Washington Avenue, Floor 8, New York, NY, 10032, USA
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266
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Jiang C, Zhang ZH, Li JX. Consideration on immunotherapy of liver metastases of malignant tumors. World J Gastrointest Surg 2024; 16:2374-2381. [PMID: 39220060 PMCID: PMC11362915 DOI: 10.4240/wjgs.v16.i8.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/05/2024] [Accepted: 06/03/2024] [Indexed: 08/16/2024] Open
Abstract
In this editorial, we comment on the article "Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis" by Liu et al that was published in the recent issue of the World Journal of Gastrointestinal Surgery. It has prompted us to think and summarize some thoughts on immunotherapy for malignant tumor liver metastasis. Immunotherapy plays a crucial role in the treatment of malignant tumors; however, the presence of liver metastases in advanced tumors may impact its efficacy. Although patients with liver metastases can still benefit from immunotherapy, multiple clinical studies have indicated that, compared to other sites of metastasis, liver metastases may diminish the effectiveness of immunotherapy. The efficacy of immune checkpoint inhibitors in patients with liver metastases often fails to reach the ideal level, primarily due to the liver metastases exploiting the host's peripheral immune tolerance mechanisms to promote systemic CD8(+) T cell exhaustion, resulting in a systemic immune-tolerant environment. This article aims to summarize the reasons for the decreased efficacy of immunotherapy following liver metastasis in various malignant tumors and propose potential clinical strategies for management.
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Affiliation(s)
- Chuang Jiang
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, and State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhi-Hong Zhang
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, and State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jia-Xin Li
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, and State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of General Surgery, Dafang County People's Hospital, Bijie 551600, Guizhou Province, China
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267
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Dehal A. Immunotherapy for gastric cancer and liver metastasis: Is it time to bid farewell. World J Gastrointest Surg 2024; 16:2365-2368. [PMID: 39220066 PMCID: PMC11362927 DOI: 10.4240/wjgs.v16.i8.2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 08/16/2024] Open
Abstract
Patients with metastatic gastric cancer have a grim prognosis. Palliative chemotherapy offers a limited survival improvement, but recent advancements in immunotherapy have sparked hope. However, the effectiveness of immunotherapy in patients with liver metastases remains debated. This article reviews a recent study by Liu et al and evaluates conflicting evidence on the impact of liver metastases on response to immunotherapy in metastatic gastric cancer. While some studies suggest no significant difference in treatment response based on liver involvement, others report varied response rates. The present study, a retrospective analysis of 48 patients by Liu et al, examines this issue and concludes that immunotherapy is less effective in patients with liver metastases. Despite methodological limitations and a small sample size, the study contributes to the ongoing discourse. The nuanced response to immunotherapy in certain patients underscores the importance of understanding the tumor microenvironment, immune cell infiltration, and the expression of immune checkpoints. Rather than dismissing immunotherapy for patients with gastric cancer and liver metastases, a shift towards personalized treatment strategies and a more profound understanding of tumor-specific biomarkers is essential. By unraveling the molecular intricacies of individual cases, clinicians may tailor more effective and customized treatments, offering a glimmer of hope for this challenging patient group.
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Affiliation(s)
- Ahmed Dehal
- Department of Clinical Sciences, Kaiser Permanente School of Medicine, Panorama, CA 91402, United States
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268
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Lambrou I, Mantzoros I, Ioannidis O, Tatsis D, Anestiadou E, Bisbinas V, Pramateftakis MG, Kotidis E, Driagka B, Kerasidou O, Symeonidis S, Bitsianis S, Sifaki F, Angelopoulos K, Demetriades H, Angelopoulos S. Effect of growth hormone on colonic anastomosis after intraperitoneal administration of 5-fluorouracil, bleomycin and cisplatin: An experimental study. World J Gastrointest Surg 2024; 16:2679-2688. [PMID: 39220091 PMCID: PMC11362934 DOI: 10.4240/wjgs.v16.i8.2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/20/2024] [Accepted: 06/17/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Growth hormone (GH) plays a crucial role in wound healing and tissue repair in postoperative patients. In particular, colonic anastomosis healing following colorectal surgery is impaired by numerous chemotherapy agents. AIM To investigate whether GH can improve the healing of a colonic anastomosis following the adverse effects of intraperitoneal administration of 5-fluorouracil (5-FU), bleomycin and cisplatin. METHODS Eighty Wistar rats underwent laparotomy and a 1 cm-resection of the transverse colon, followed by an end-to-end anastomosis under general anesthesia. The rats were blindly allocated into four equal groups and administered a different daily intraperitoneal therapeutic regimen for 6 days. The control group (A) received normal saline. Group B received chemotherapy with 5-FU (20 mg/kg), bleomycin (4 mg/kg) and cisplatin (0.7 mg/kg). Group C received GH (2 mg/kg), and group D received the aforementioned combination chemotherapy and GH, as described. The rats were sacrificed on the 7th postoperative day and the anastomoses were macroscopically and microscopically examined. Body weight, bursting pressure, hydroxyproline levels and inflammation markers were measured. RESULTS All rats survived until the day of sacrifice, with no infections or other complications. A decrease in the body weight of group D rats was observed, not statistically significant compared to group A (P = 1), but significantly different to groups C (P = 0.001) and B (P < 0.01). Anastomotic dehiscence rate was not statistically different between the groups. Bursting pressure was not significantly different between groups A and D (P = 1.0), whereas group B had a significantly lower bursting pressure compared to group D (P < 0.001). All groups had significantly more adhesions than group A. Hydroxyproline, as a measurement of collagen deposition, was significantly higher in group D compared to group B (P < 0.05), and higher, but not statistically significant, compared to group A. Significant changes in group D were recorded, compared to group A regarding inflammation (3.450 vs 2.900, P = 0.016) and fibroblast activity (2.75 vs 3.25, P = 0.021). Neoangiogenesis and collagen deposition were not significantly different between groups A and D. Collagen deposition was significantly increased in group D compared to group B (P < 0.001). CONCLUSION Intraperitoneal administration of chemotherapy has an adverse effect on the healing process of colonic anastomosis. However, GH can inhibit the deleterious effect of administered chemotherapy agents and induce colonic healing in rats.
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Affiliation(s)
- Ioannis Lambrou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Ioannis Mantzoros
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitrios Tatsis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Vasiliki Bisbinas
- Department of ENT, Royal Cornwall Hospitals NHS Trust, Cornwall TR1 3LJ, United Kingdom
| | | | - Efstathios Kotidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Barbara Driagka
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Ourania Kerasidou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Savvas Symeonidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Freideriki Sifaki
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Konstantinos Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Haralabos Demetriades
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stamatios Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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269
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Xing XW, Huang X, Li WP, Wang MK, Yang JS. Clinical application value of long non-coding RNAs signatures of genomic instability in predicting prognosis of hepatocellular carcinoma. World J Gastrointest Surg 2024; 16:2386-2392. [PMID: 39220063 PMCID: PMC11362949 DOI: 10.4240/wjgs.v16.i8.2386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 08/16/2024] Open
Abstract
Hepatocellular carcinoma (HCC) presents challenges due to its high recurrence and metastasis rates and poor prognosis. While current clinical diagnostic and prognostic indicators exist, their accuracy remains imperfect due to their biological complexity. Therefore, there is a quest to identify improved biomarkers for HCC diagnosis and prognosis. By combining long non-coding RNA (lncRNA) expression and somatic mutations, Duan et al identified five representative lncRNAs from 88 lncRNAs related to genomic instability (GI), forming a GI-derived lncRNA signature (LncSig). This signature outperforms previously reported LncSig and TP53 mutations in predicting HCC prognosis. In this editorial, we comprehensively evaluate the clinical application value of such prognostic evaluation model based on sequencing technology in terms of cost, time, and practicability. Additionally, we provide an overview of various prognostic models for HCC, aiding in a comprehensive understanding of research progress in prognostic evaluation methods.
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Affiliation(s)
- Xiao-Wen Xing
- Department of Disease Control and Prevention, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Xiao Huang
- Department of Disease Control and Prevention, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Wei-Peng Li
- Department of Disease Control and Prevention, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical University, Shanghai 200052, China
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270
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Senatore AM, Mongelli F, Mion FU, Lucchelli M, Garofalo F. Costs of Robotic and Laparoscopic Bariatric Surgery: A Retrospective Propensity Score-matched Analysis. Obes Surg 2024:10.1007/s11695-024-07477-x. [PMID: 39190261 DOI: 10.1007/s11695-024-07477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 08/28/2024]
Abstract
PURPOSE Robotic bariatric surgery has not shown significant advantages compared to laparoscopy, yet costs remain a major concern. The aim of our study was to assess costs of robotic and laparoscopic bariatric surgery. MATERIALS AND METHODS We retrospectively collected data of all patients who underwent either robotic or laparoscopic bariatric surgery at our institution. We retrieved demographics, clinical characteristics, postoperative data, and costs using a bottom-up approach. The primary endpoint was hospital costs in the robotic and laparoscopic groups. Data was analyzed using a propensity score matching. RESULTS Out of the total 122 patients enrolled in the study, 42 were subsequently chosen based on propensity scores, with 21 patients allocated to each group. No difference in clinical characteristics and postoperative outcomes were noted. Length of hospital stay was 2.4 ± 0.7 days vs. 2.6 ± 1.1 days (p = 0.520). In the robotic and laparoscopic groups, total costs were USD 16,275 ± 4018 vs. 12,690 ± 2834 (absolute difference USD 3585, 95%CI 1416-5753, p = 0.002), direct costs were USD 5037 ± 1282 vs. 3720 ± 1308 (absolute difference USD 1316, 95% CI 509-2214, p = 0.002), and indirect costs were USD 11,238 ± 3234 vs. 8970 ± 3021 (absolute difference USD 2,268, 95% CI 317-4220, p = 0.024). Subgroup analyses revealed a decreasing trend in the cost difference in patients undergoing primary gastric bypass and revisional surgery. CONCLUSIONS Overall hospital costs were higher in patients operated on with the robotic system than with laparoscopy, yet a clinical advantage has not been demonstrated so far. Subgroup analyses showed lesser disparity in costs among patients undergoing revisional bariatric surgery, where robotics are likely to be more worthwhile.
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Affiliation(s)
- Anna M Senatore
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Bellinzona e Valli Regional Hospital, EOC, Via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via la Santa 1, 6900, Lugano, Switzerland.
| | - Federico U Mion
- Finance Department, Lugano Regional Hospital, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Massimo Lucchelli
- Finance Department, Lugano Regional Hospital, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
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271
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Sun XM, Liu K, Wu W, Meng C. Survival prognostic analysis of laparoscopic D2 radical resection for locally advanced gastric cancer: A multicenter cohort study. World J Gastrointest Surg 2024; 16:2451-2460. [PMID: 39220087 PMCID: PMC11362923 DOI: 10.4240/wjgs.v16.i8.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 06/07/2024] [Accepted: 06/25/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND With the development of minimally invasive surgical techniques, the use of laparoscopic D2 radical surgery for the treatment of locally advanced gastric cancer (GC) has gradually increased. However, the effect of this procedure on survival and prognosis remains controversial. This study evaluated the survival and prognosis of patients receiving laparoscopic D2 radical resection for the treatment of locally advanced GC to provide more reliable clinical evidence, guide clinical decision-making, optimize treatment strategies, and improve the survival rate and quality of life of patients. AIM To investigate the survival prognosis and influencing factors of laparoscopic D2 radical resection for locally advanced GC patients. METHODS A retrospective cohort study was performed. Clinicopathological data from 652 patients with locally advanced GC in our hospitals from December 2013 to December 2023 were collected. There were 442 males and 210 females. The mean age was 57 ± 12 years. All patients underwent a laparoscopic D2 radical operation for distal GC. The patients were followed up in the outpatient department and by telephone to determine their tumor recurrence, metastasis, and survival. The follow-up period ended in December 2023. Normally distributed data are expressed as the mean ± SD, and normally distributed data are expressed as M (Q1, Q3) or M (range). Statistical data are expressed as absolute numbers or percentages; the χ 2 test was used for comparisons between groups, and the Mann-Whitney U nonparametric test was used for comparisons of rank data. The life table method was used to calculate the survival rate, the Kaplan-Meier method was used to construct survival curves, the log rank test was used for survival analysis, and the Cox risk regression model was used for univariate and multifactor analysis. RESULTS The median overall survival (OS) time for the 652 patients was 81 months, with a 10-year OS rate of 46.1%. Patients with TNM stages II and III had 10-year OS rates of 59.6% and 37.5%, respectively, which were significantly different (P < 0.05). Univariate analysis indicated that factors such as age, maximum tumor diameter, tumor differentiation grade (low to undifferentiated), pathological TNM stage, pathological T stage, pathological N stage (N2, N3), and postoperative chemotherapy significantly influenced the 10-year OS rate for patients with locally advanced GC following laparoscopic D2 radical resection for distal stomach cancer [hazard ratio (HR): 1.45, 1.64, 1.45, 1.64, 1.37, 2.05, 1.30, 1.68, 3.08, and 0.56 with confidence intervals (CIs) of 1.15-1.84, 1.32-2.03, 1.05-1.77, 1.62-2.59, 1.05-1.61, 1.17-2.42, 2.15-4.41, and 0.44-0.70, respectively; P < 0.05]. Multifactor analysis revealed that a tumor diameter greater than 4 cm, low tumor differentiation, and pathological TNM stage III were independent risk factors for the 10-year OS rate in these patients (HR: 1.48, 1.44, 1.81 with a 95%CI: 1.19-1.84). Additionally, postoperative chemotherapy emerged as an independent protective factor for the 10-year OS rate (HR: 0.57, 95%CI: 0.45-0.73; P < 0.05). CONCLUSION A maximum tumor diameter exceeding 4 cm, low tumor differentiation, and pathological TNM stage III were identified as independent risk factors for the 10-year OS rate in patients with locally advanced GC following laparoscopic D2 radical resection for distal GC. Conversely, postoperative chemotherapy was found to be an independent protective factor for the 10-year OS rate in these patients.
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Affiliation(s)
- Xiu-Ming Sun
- Department of Pain Management, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Kui Liu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Wen Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Chao Meng
- Department of Pain Management, Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
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272
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Jacenik D, Fichna J. Treatment strategy and therapy based on immune response in patients with gastric cancers. World J Gastrointest Surg 2024; 16:2393-2395. [PMID: 39220051 PMCID: PMC11362946 DOI: 10.4240/wjgs.v16.i8.2393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/07/2024] [Accepted: 06/04/2024] [Indexed: 08/16/2024] Open
Abstract
In this editorial, we highlight the significance of a retrospective study "Analysis of the impact of immunotherapy efficacy and safety in patients with gastric cancer and liver metastasis" performed by Liu et al. The authors utilized data collected from gastric cancer (GC) patients and assessed immunotherapy effectiveness and survival status. They found significant differences in treatment response. Because immunotherapy seems to be a beneficial strategy for advanced GC patients, stratification of the data based on metastasis status may further improve treatment strategies.
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Affiliation(s)
- Damian Jacenik
- Department of Cytobiochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Lodz 90-236, Poland
| | - Jakub Fichna
- Department of Biochemistry, Medical University of Lodz, Lodz 92-215, Poland
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273
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Iijima S. Use of Traditional Japanese Herbal Medicine Daikenchuto for the Treatment of Abdominal Distention in Very-Low-Birth-Weight Infants. J Clin Med 2024; 13:5082. [PMID: 39274296 PMCID: PMC11396189 DOI: 10.3390/jcm13175082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/08/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Background: Very-low-birth-weight (VLBW) infants often experience feeding intolerance owing to organ immaturity, and the most frequent sign is the presence of abdominal distention. Daikenchuto (DKT), a traditional Japanese herbal medicine, is used to improve gastrointestinal function, particularly in adults. The aim of this study was to investigate the effectiveness of DKT in reducing abdominal distention and intestinal gas in VLBW infants. Methods: This study involved a retrospective chart review of 24 VLBW infants treated with DKT at Hamamatsu University Hospital between April 2016 and March 2021. The effects of DKT treatment at a dose of 0.3 g/kg/day were evaluated through clinical parameters and abdominal radiography. Results: Before treatment, marked abdominal distention was observed in 46% of the infants, which reduced to 4% within a week of DKT administration. The gas volume score (GVS) decreased in 92% of the patients within the first week of treatment and markedly decreased by ≥20% in 46% of the patients. The effects of improving abdominal distention and decreasing the GVS on radiography persisted for 1-2 weeks after treatment initiation. No clinical parameters affecting a GVS reduction of ≥20% and no notable adverse effects were observed. Conclusions: While the preliminary findings suggest that DKT may help manage abdominal distention in VLBW infants, further studies with placebo-controlled trials, larger sample sizes, use of advanced image processing software, and consideration of additional influencing factors are required to substantiate these results and identify predictors of treatment response.
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Affiliation(s)
- Shigeo Iijima
- Department of Regional Neonatal-Perinatal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
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274
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Kang LM, Xu L, Zhang FW, Yu FK, Lang L. Efficiency and safety of laparoscopic left hemihepatectomy: A study of intrathecal vs extrathecal Glissonean pedicle techniques. World J Gastrointest Surg 2024; 16:2612-2619. [PMID: 39220081 PMCID: PMC11362945 DOI: 10.4240/wjgs.v16.i8.2612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/29/2024] [Accepted: 07/17/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Selective hemihepatic vascular occlusion is utilized in both right and left hemihepatectomies to preserve blood supply to the intact lobe, maintain hemodynamic stability, and mitigate surgical risks. While this technique encompasses both intrathecal and extrathecal Glissonean pedicle transection methods, there is a lack of systematic comparative reports on these two approaches. AIM To retrospectively analyze the clinical data of patients with hepatocellular carcinoma (HCC) undergoing laparoscopic anatomical hepatectomy in our hospital to explore the feasibility, safety, and short- and long-term efficacy of extrathecal and intrathecal Glissonean pedicle transection methods in laparoscopic left hemihepatectomy. METHODS A retrospective study was performed to analyze the clinical data of 49 HCC patients who underwent laparoscopic left hemihepatectomy from January 2019 to December 2022 in our hospital. These patients were divided into extrathecal Glissonean pedicle transection (EGP) group (n = 24) and intrathecal Glissonean pedicle transection (IGP) group (n = 25) according to the different approaches used for selective hemihepatic vascular occlusion. The perioperative indicators, liver function indexes, complications, and follow-up findings were compared between these two groups. RESULTS The surgeries were smooth in both groups, and no perioperative death was noted. The hepatic pedicle transection time and the operation time were (16.1 ± 2.3) minutes and (129.6 ± 19.0) minutes, respectively, in the EGP group, which were significantly shorter than those in the IGP group [(25.5 ± 2.4) minutes and (184.8 ± 26.0) minutes, respectively], both P < 0.01. There were no significant differences in intraoperative blood loss, time to anal exhaust, hospital stay, drain indwelling time, and postoperative liver function between the two groups (all P > 0.05). The incidence of postoperative complications showed no significant difference [16.67% (4/24) vs 16.0% (4/25), P > 0.05). All the 49 HCC patients were followed up after surgery (range: 11.2-53.3 months; median: 36.4 months). The overall survival rate and disease-free survival rate were not significantly different (both P > 0.05). CONCLUSION Both extrathecal and intrathecal Glissonean pedicle approaches are effective and safe hepatic inflow occlusion techniques in laparoscopic left hemihepatectomy for HCC. However, the extrathecal approach simplifies the hepatic pedicle transection, shortens the operation time, and increases the surgical efficiency, making it a more feasible technique.
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Affiliation(s)
- Li-Min Kang
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
| | - Lei Xu
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
| | - Fu-Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
| | - Fa-Kun Yu
- Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
| | - Li Lang
- Department of Outpatient, Puer People's Hospital, Puer 665000, Yunnan Province, China
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275
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Zhang LF, Chen LX, Yang WJ, Hu B. Machine learning in predicting postoperative complications in Crohn's disease. World J Gastrointest Surg 2024; 16:2745-2747. [PMID: 39220079 PMCID: PMC11362926 DOI: 10.4240/wjgs.v16.i8.2745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 07/06/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory bowel disease of unknown origin that can cause significant disability and morbidity with its progression. Due to the unique nature of CD, surgery is often necessary for many patients during their lifetime, and the incidence of postoperative complications is high, which can affect the prognosis of patients. Therefore, it is essential to identify and manage postoperative complications. Machine learning (ML) has become increasingly important in the medical field, and ML-based models can be used to predict postoperative complications of intestinal resection for CD. Recently, a valuable article titled "Predicting short-term major postoperative complications in intestinal resection for Crohn's disease: A machine learning-based study" was published by Wang et al. We appreciate the authors' creative work, and we are willing to share our views and discuss them with the authors.
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Affiliation(s)
- Li-Fan Zhang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Liu-Xiang Chen
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Juan Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bing Hu
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Digestive Endoscopy Medical Engineering Research Laboratory, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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276
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Colombo PE, Druet C, Mourregot A, Riou O, Rouanet P, Taoum C. Robotic posterior pelvic exenteration for locally advanced rectal cancer-A video vignette. Colorectal Dis 2024. [PMID: 39189696 DOI: 10.1111/codi.17147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024]
Affiliation(s)
- Pierre-Emmanuel Colombo
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Chloé Druet
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Anne Mourregot
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Olivier Riou
- Department of Radiotherapy, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Philippe Rouanet
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - Christophe Taoum
- Department of Surgical Oncology, Institut du Cancer de Montpellier (ICM), Montpellier, France
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277
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Singh S, Chandan S, Facciorusso A. Role of endoscopic ultrasound-guided biliary drainage for palliation of malignant biliary obstruction. World J Gastrointest Surg 2024; 16:2369-2373. [PMID: 39220057 PMCID: PMC11362943 DOI: 10.4240/wjgs.v16.i8.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/15/2024] [Accepted: 06/03/2024] [Indexed: 08/16/2024] Open
Abstract
Endoscopic ultrasound-guided biliary drainage (EUS-BD) directs bile flow into the digestive tract and has been mostly used in patients with malignant biliary obstruction (MBO) where endoscopic retrograde cholangiopancreatography-guided biliary drainage was unsuccessful or was not feasible. Lumen apposing metal stents (LAMS) are deployed during EUS-BD, with the newer electrocautery-enhanced LAMS reducing procedure time and complication rates due to the inbuilt cautery at the catheter tip. EUS-BD with electrocautery-enhanced LAMS has high technical and clinical success rates for palliation of MBO, with bleeding, cholangitis, and stent occlusion being the most common adverse events. Recent studies have even suggested comparable efficacy between EUS-BD and endoscopic retrograde cholangiopancreatography as the primary approach for distal MBO. In this editorial, we commented on the article by Peng et al published in the recent issue of the World Journal of Gastrointestinal Surgery in 2024.
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Affiliation(s)
- Sahib Singh
- Department of Internal Medicine, Sinai Hospital, Baltimore, MD 21215, United States
| | - Saurabh Chandan
- Center for Interventional Endoscopy (CIE), Advent Health, Orlando, FL 32803, United States
| | - Antonio Facciorusso
- Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia 71122, Italy
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278
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Perini D, Cammelli F, Scheiterle M, Martellucci J, Di Bella A, Bergamini C, Prosperi P, Giordano A. Beyond total mesorectal excision: The emerging role of minimally invasive surgery for locally advanced rectal cancer. World J Gastrointest Surg 2024; 16:2382-2385. [PMID: 39220075 PMCID: PMC11362916 DOI: 10.4240/wjgs.v16.i8.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/07/2024] [Accepted: 06/05/2024] [Indexed: 08/16/2024] Open
Abstract
Multivisceral resection and/or pelvic exenteration represents the only potential curative treatment for locally advanced rectal cancer (LARC); however, it poses significant technical challenges, which account for the high risk of morbidity and mortality associated with the procedure. As complete histopathologic resection is the most important determinant of patient outcomes, LARC often requires an extended resection beyond the total mesorectal excision plane to obtain clear resection margins. In an era when laparoscopic surgery and robot-assisted surgery are becoming commonplace, the optimal approach to extensive pelvic interventions remains controversial. However, acceptance of the suitability of minimally invasive surgery is slowly gaining traction. Nonetheless, there is still a lack of evidence in the literature about minimally invasive approaches in multiple and extensive surgical resections, highlighting the need for research studies to explore, validate, and develop this issue. This editorial aims to provide a critical overview of the currently available applications and challenges of minimally invasive abdominopelvic surgery for LARC. Furthermore, we discuss recent developments in the field of robotic surgery for LARC, with a specific focus on new innovations and emerging frontiers.
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Affiliation(s)
- Davina Perini
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
| | - Francesca Cammelli
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
| | - Maximilian Scheiterle
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
| | - Jacopo Martellucci
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
| | - Annamaria Di Bella
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
| | - Carlo Bergamini
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
| | - Paolo Prosperi
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
| | - Alessio Giordano
- Department of Emergency and Acceptance, Emergency Surgery Unit, Careggi University Hospital, Firenze 50137, Italy
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279
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He F, Qu SP, Yuan Y, Qian K. Lymph node dissection does not affect the survival of patients with tumor node metastasis stages I and II colorectal cancer. World J Gastrointest Surg 2024; 16:2503-2510. [PMID: 39220053 PMCID: PMC11362951 DOI: 10.4240/wjgs.v16.i8.2503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND The effect of the number of lymph node dissections (LNDs) during radical resection for colorectal cancer (CRC) on overall survival (OS) remains controversial. AIM To investigate the association between the number of LNDs and OS in patients with tumor node metastasis (TNM) stage I-II CRC undergoing radical resection. METHODS Patients who underwent radical resection for CRC at a single-center hospital between January 2011 and December 2021 were retrospectively analyzed. Cox regression analyses were performed to identify the independent predictors of OS at different T stages. RESULTS A total of 2850 patients who underwent laparoscopic radical resection for CRC were enrolled. At stage T1, age [P < 0.01, hazard ratio (HR) = 1.075, 95% confidence interval (CI): 1.019-1.134] and tumour size (P = 0.021, HR = 3.635, 95%CI: 1.210-10.917) were independent risk factors for OS. At stage T2, age (P < 0.01, HR = 1.064, 95%CI: 1.032-1.098) and overall complications (P = 0.012, HR = 2.297, 95%CI: 1.200-4.397) were independent risk factors for OS. At stage T3, only age (P < 0.01, HR = 1.047, 95%CI: 1.027-1.066) was an independent risk factor for OS. At stage T4, age (P < 0.01, HR = 1.057, 95%CI: 1.039-1.075) and body mass index (P = 0. 034, HR = 0.941, 95%CI: 0.890-0.995) were independent risk factors for OS. However, there was no association between LNDs and OS in stages I and II. CONCLUSION The number of LDNs did not affect the survival of patients with TNM stages I and II CRC. Therefore, insufficient LNDs should not be a cause for alarm during the surgery.
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Affiliation(s)
- Fan He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shu-Pei Qu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Ye Yuan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Kun Qian
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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280
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Hou P, Wu HJ, Li T, Liu JB, Zhao QQ, Zhao HJ, Liu ZM. Prediction model establishment and validation for enteral nutrition aspiration during hospitalization in patients with acute pancreatitis. World J Gastrointest Surg 2024; 16:2583-2591. [PMID: 39220076 PMCID: PMC11362931 DOI: 10.4240/wjgs.v16.i8.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/11/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Acute pancreatitis (AP) is a disease caused by abnormal activation of pancreatic enzymes and can lead to self-digestion of pancreatic tissues and dysfunction of other organs. Enteral nutrition plays a vital role in the treatment of AP because it can meet the nutritional needs of patients, promote the recovery of intestinal function, and maintain the barrier and immune functions of the intestine. However, the risk of aspiration during enteral nutrition is high; once aspiration occurs, it may cause serious complications, such as aspiration pneumonia, and suffocation, posing a threat to the patient's life. This study aims to establish and validate a prediction model for enteral nutrition aspiration during hospitalization in patients with AP. AIM To establish and validate a predictive model for enteral nutrition aspiration during hospitalization in patients with AP. METHODS A retrospective review was conducted on 200 patients with AP admitted to Chengdu Shangjin Nanfu Hospital, West China Hospital of Sichuan University from January 2020 to February 2024. Clinical data were collected from the electronic medical record system. Patients were randomly divided into a validation group (n = 40) and a modeling group (n = 160) in a 1:4 ratio, matched with 200 patients from the same time period. The modeling group was further categorized into an aspiration group (n = 25) and a non-aspiration group (n = 175) based on the occurrence of enteral nutrition aspiration during hospitalization. Univariate and multivariate logistic regression analyses were performed to identify factors influencing enteral nutrition aspiration in patients with AP during hospitalization. A prediction model for enteral nutrition aspiration during hospitalization was constructed, and calibration curves were used for validation. Receiver operating characteristic curve analysis was conducted to evaluate the predictive value of the model. RESULTS There was no statistically significant difference in general data between the validation and modeling groups (P > 0.05). The comparison of age, gender, body mass index, smoking history, hypertension history, and diabetes history showed no statistically significant difference between the two groups (P > 0.05). However, patient position, consciousness status, nutritional risk, Acute Physiology and Chronic Health Evaluation (APACHE-II) score, and length of nasogastric tube placement showed statistically significant differences (P < 0.05) between the two groups. Multivariate logistic regression analysis showed that patient position, consciousness status, nutritional risk, APACHE-II score, and length of nasogastric tube placement were independent factors influencing enteral nutrition aspiration in patients with AP during hospitalization (P < 0.05). These factors were incorporated into the prediction model, which showed good consistency between the predicted and actual risks, as indicated by calibration curves with slopes close to 1 in the training and validation sets. Receiver operating characteristic analysis revealed an area under the curve (AUC) of 0.926 (95%CI: 0.8889-0.9675) in the training set. The optimal cutoff value is 0.73, with a sensitivity of 88.4 and specificity of 85.2. In the validation set, the AUC of the model for predicting enteral nutrition aspiration in patients with AP patients during hospitalization was 0.902, with a standard error of 0.040 (95%CI: 0.8284-0.9858), and the best cutoff value was 0.73, with a sensitivity of 91.9 and specificity of 81.8. CONCLUSION A prediction model for enteral nutrition aspiration during hospitalization in patients with AP was established and demonstrated high predictive value. Further clinical application of the model is warranted.
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Affiliation(s)
- Ping Hou
- Division II of General Surgery, West China Hospital-Chengdu Shangjin Nanfu, West China Hospital, Sichuan University, Chengdu 611730, Sichuan Province, China
| | - Hao-Jun Wu
- Division of Biliary Tract Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tang Li
- Department of Hepatobiliary and Pancreatic Surgery, West China Hospital-Chengdu Shangjin Nanfu, West China Hospital, Sichuan University, Chengdu 611730, Sichuan Province, China
| | - Jia-Bin Liu
- Department of Thyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Quan-Qing Zhao
- Department of Oncology, West China Hospital-Chengdu Shangjin Nanfu, West China Hospital, Sichuan University, Chengdu 611730, Sichuan Province, China
| | - Hong-Jiang Zhao
- Division II of General Surgery, West China Hospital-Chengdu Shangjin Nanfu, West China Hospital, Sichuan University, Chengdu 611730, Sichuan Province, China
| | - Zi-Ming Liu
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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281
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Pather K, Alabbas H, Gonzalez-Baerga C, Menendez M, Virarkar MK, de Oliveira IS, Mobley EM, Awad ZT. Major coronary artery calcifications as predictors of postoperative complications in Ivor Lewis esophagectomies: a five-year retrospective analysis. Surg Endosc 2024:10.1007/s00464-024-11181-3. [PMID: 39187729 DOI: 10.1007/s00464-024-11181-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/09/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND This study aimed to determine the relationship between preoperative arterial calcifications and postoperative outcomes after Ivor Lewis esophagectomies. METHODS This was a single-center retrospective review of Ivor Lewis esophagectomies from 2013 to 2018. Preoperative CT imaging was reviewed, and arterial calcifications were graded (absent, minor, or major) in various locations. The primary outcome included major complications (defined by the Clavien-Dindo classification III-V) and the secondary outcomes were 90-day reoperations, readmissions, and mortality. Significant associations (p < 0.05) between calcifications and outcomes on univariable analysis were evaluated using a multivariable logistic regression model (odds ratios, OR; 95% confidence intervals, CI). RESULTS One hundred patients underwent esophagectomies from 2013 to 2018 (79% male, 90% White, median age 68 years), and 85% were classified as ASA III. Ninety-four patients had accessible preoperative imaging. Arterial calcifications in specific areas were observed: 82 in coronary arteries (major in 33 patients), 54 in the aortic valve, 78 in supra-aortic arteries, 79 in the thoracic aorta, 82 in the abdominal aorta, and 71 in common iliac. Furthermore, 60 patients exhibited celiac axis calcifications, with 40 patients classified as major. Twenty-five patients experienced major complications. Anastomotic leak occurred in two patients, and graft necrosis occurred in one patient. Ninety-day readmission was 10%, reoperation was 12%, and mortality was 4%. On univariable analysis, major coronary artery calcifications were significantly associated with major complications (OR 4.04; 95% CI 1.34-12.16; p = 0.02) and 90-day readmissions (OR 8.20; 95% CI 1.01-68.47; p = 0.04). However, no significant associations were identified between 90-day reoperations or mortality and arterial calcifications. CONCLUSIONS This study demonstrated that preoperative coronary calcifications increase the risk of postoperative complications, as this may be a surrogate of overall health. Nonetheless, the correlation between splanchnic calcifications and postoperative outcomes needs further exploration.
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Affiliation(s)
- Keouna Pather
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
| | - Haytham Alabbas
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Carlos Gonzalez-Baerga
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Manuel Menendez
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Mayur K Virarkar
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Irai Santana de Oliveira
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA
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282
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Soldera J. Navigating treatment resistance: Janus kinase inhibitors for ulcerative colitis. World J Clin Cases 2024; 12:5468-5472. [PMID: 39188602 PMCID: PMC11269992 DOI: 10.12998/wjcc.v12.i24.5468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/20/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024] Open
Abstract
The management of refractory ulcerative colitis (UC) and acute severe UC (ASUC) is challenging due to the lack of standardized approaches in cases resistant to multiple treatments. In this editorial, I investigate the efficacy and safety of Janus kinase inhibitors, particularly upadacitinib and tofacitinib, in controlling severe and refractory disease. I highlight a notable case report by Xu et al, which explores the case of a patient with primary nonresponse to two classes of biologics and two fecal microbiota transplants who exhibited a remarkable response to upadacitinib. Furthermore, I discuss the use of tofacitinib in refractory UC and ASUC, either as monotherapy or in combination with biologics, which has shown promising response rates. Additionally, emerging evidence of upadacitinib efficacy in ASUC is presented. Overall, these cases emphasize the complex nature of managing refractory ASUC and the potential of small-molecule therapies to achieve remission. Further research is needed to refine treatment strategies for patients with treatment-resistant UC.
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Affiliation(s)
- Jonathan Soldera
- Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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283
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Li ZR, Cheng YC, Hong ZJ. Diagnostic laparoscopy with indocyanine green fluorescence test for the evaluation of intestinal perfusion in abdominal blunt injury: a case report. Int J Emerg Med 2024; 17:100. [PMID: 39187750 PMCID: PMC11345953 DOI: 10.1186/s12245-024-00684-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 08/18/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The indocyanine green (ICG) fluorescence test has become a standard test in surgical procedures, facilitating the assessment of blood perfusion in real-time. While its utility in emergency surgeries for evaluating anastomotic blood supply is well-established, its application in trauma cases, especially those involving mesenteric hematoma, remains underexplored. Herein, we present a case to illustrate the efficacy of the ICG fluorescence test in such scenarios. CASE PRESENTATION A 51-year-old man with uncontrolled hypertension suffered blunt abdominal trauma following a motor vehicle accident. We used the intra-operative ICG fluorescence test to chart the surgical plan for the patient. A combination of diagnostic laparoscopy with ICG fluorescence testing effectively excluded bowel ischemia, leading to the avoidance of intestinal resection and the need for a temporary ostomy. The patient resumed enteral nutrition. CONCLUSIONS Our case underscores the efficacy of ICG fluorescence testing in assessing bowel viability and guiding surgical strategies in trauma patients with mesenteric hematoma. By facilitating real-time visualization of blood perfusion, ICG testing enables the adoption of conservative treatments in patients who would traditionally require more invasive surgical interventions, with minimal effect on operation time and cost.
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Affiliation(s)
- Ze-Rui Li
- Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Chiao Cheng
- Division of Colon and Rectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Zhi-Jie Hong
- Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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284
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Li X, Ouyang J, Dai J. Current Gallstone Treatment Methods, State of the Art. Diseases 2024; 12:197. [PMID: 39329866 PMCID: PMC11431374 DOI: 10.3390/diseases12090197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 08/18/2024] [Accepted: 08/21/2024] [Indexed: 09/28/2024] Open
Abstract
This study aims to provide valuable references for clinicians in selecting appropriate surgical methods for biliary tract stones based on patient conditions. In this paper, the advantages and disadvantages of various minimally invasive cholelithiasis surgical techniques are systematically summarized and innovative surgical approaches and intelligent stone removal technologies are introduced. The goal is to evaluate and predict future research priorities and development trends in the field of gallstone surgery. In recent years, the incidence of gallstone-related diseases, including cholecystolithiasis and choledocholithiasis, has significantly increased. This surge in cases has prompted the development of several innovative methods for gallstone extraction, with minimally invasive procedures gaining the most popularity. Among these techniques, PTCS, ERCP, and LCBDE have garnered considerable attention, leading to new surgical techniques; however, it must be acknowledged that each surgical method has its unique indications and potential complications. The primary challenge for clinicians is selecting a surgical approach that minimizes patient trauma while reducing the incidence of complications such as pancreatitis and gallbladder cancer and preventing the recurrence of gallstones. The integration of artificial intelligence with stone extraction surgeries offers new opportunities to address this issue. Regarding the need for preoperative preparation for PTCS surgery, we recommend a combined approach of PTBD and PTOBF. For ERCP-based stone extraction, we recommend a small incision of the Oddi sphincter followed by 30 s of balloon dilation as the optimal procedure. If conditions permit, a biliary stent can be placed post-extraction. For the surgical approach of LCBDE, we recommend the transduodenal (TD) approach. Artificial intelligence is involved throughout the entire process of gallstone detection, treatment, and prognosis, and more AI-integrated medical technologies are expected to be applied in the future.
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Affiliation(s)
- Xiangtian Li
- The Second Clinical Medical College, Southern Medical University, Guangzhou 510280, China;
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual, Reality Experimental Education Center for Medical Morphology (Southern Medical University), National Key Discipline of Human Anatomy School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China;
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Digital Medicine and Biomechanics, Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, National Virtual, Reality Experimental Education Center for Medical Morphology (Southern Medical University), National Key Discipline of Human Anatomy School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China;
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285
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Samasca G, Burz C, Pintea I, Muntean A, Deleanu D, Lupan I, Bintintan V. A New Medical Evaluation for Gastric Cancer Patients to Increase the Success Rate of Immunotherapy: A 2024 Update. Pharmaceuticals (Basel) 2024; 17:1121. [PMID: 39338286 PMCID: PMC11435362 DOI: 10.3390/ph17091121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/11/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024] Open
Abstract
Researchers have performed numerous studies on immunotherapy because of the high death rate associated with gastric cancer (GC). GC immunotherapy research has made tremendous progress, and we wanted to provide an update on this topic. On the basis of this update, we suggest performing a new medical evaluation before initiating immunotherapy in patients with GC to increase the success rate of immunotherapies. We propose that before patients start GC immunotherapy, they should be evaluated and given a score of one to two points for the following factors: immunopathological features, molecular and genomic features, potential consequences for bacterial pathogens, potential immunotherapeutic resistance and hyperprogressive illness, and the potential to use biomarkers to gauge their prognosis and immunotherapy responses to optimize immunotherapy following surgery. The proposed scoring system could also help in the diagnosis of GC. With all the advances in genetics, immunology, and microbiology, the diagnosis of GC could be improved, not changed. Currently, patients diagnosed with GC undergo surgical resection as the only permanent solution. Patients who meet the maximum score from the presented proposal could be eligible immediately after diagnosis for immunotherapy. Therefore, immunotherapy could be a first-line option for clinicians.
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Affiliation(s)
- Gabriel Samasca
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Claudia Burz
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
- Institute of Oncology, "Prof. Ion Chiricuta", 400015 Cluj-Napoca, Romania
| | - Irena Pintea
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Adriana Muntean
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Diana Deleanu
- Department of Immunology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Iulia Lupan
- Department of Molecular Biology, Babes-Bolyai University, 400084 Cluj-Napoca, Romania
| | - Vasile Bintintan
- Department of Surgery 1, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
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286
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Mastrovangelis C, Frost C, Hort A, Laurence J, Pang T, Pleass H. Normothermic Regional Perfusion in Controlled Donation After Circulatory Death Liver Transplantation: A Systematic Review and Meta-Analysis. Transpl Int 2024; 37:13263. [PMID: 39246548 PMCID: PMC11377255 DOI: 10.3389/ti.2024.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/13/2024] [Indexed: 09/10/2024]
Abstract
Liver grafts from controlled donation after circulatory death (cDCD) donors have lower utilization rates due to inferior graft and patient survival rates, largely attributable to the increased incidence of ischemic cholangiopathy, when compared with grafts from brain dead donors (DBD). Normothermic regional perfusion (NRP) may improve the quality of cDCD livers to allow for expansion of the donor pool, helping to alleviate the shortage of transplantable grafts. A systematic review and metanalysis was conducted comparing NRP cDCD livers with both non-NRP cDCD livers and DBD livers. In comparison to non-NRP cDCD outcomes, NRP cDCD grafts had lower rates of ischemic cholangiopathy [RR = 0.23, 95% CI (0.11, 0.49), p = 0.0002], primary non-function [RR = 0.51, 95% CI (0.27, 0.97), p = 0.04], and recipient death [HR = 0.5, 95% CI (0.36, 0.69), p < 0.0001]. There was no difference in outcomes between NRP cDCD donation compared to DBD liver donation. In conclusion, NRP improved the quality of cDCD livers compared to their non-NRP counterparts. NRP cDCD livers had similar outcomes to DBD grafts. This provides further evidence supporting the continued use of NRP in cDCD liver transplantation and offers weight to proposals for its more widespread adoption.
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Affiliation(s)
- Carly Mastrovangelis
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Charles Frost
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amy Hort
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Westmead, NSW, Australia
| | - Jerome Laurence
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Westmead, NSW, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Tony Pang
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Westmead, NSW, Australia
- Surgical Innovations Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Henry Pleass
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Westmead Hospital, Westmead, NSW, Australia
- Department of Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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287
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Silva AF, Bestetti AM, Kum AST, Nunes BCM, de Oliveira Veras M, Bernardo WM, de Moura EGH. Effectiveness and Safety of the Allurion Swallowable Intragastric Balloon for Short-term Weight Loss: A Systematic Review and Meta-analysis. Obes Surg 2024:10.1007/s11695-024-07453-5. [PMID: 39174862 DOI: 10.1007/s11695-024-07453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 07/29/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Obesity poses a severe health problem worldwide, with an estimated impact on 17.5% of the adult population by 2035. Among the endoscopic applications for treating this comorbidity, intragastric balloons are the most widely used. The new liquid-filled swallowable balloon meets the requirements of major guidelines and allows significant weight loss with few adverse events. This systematic review and meta-analysis aims to demonstrate the efficacy and safety profile of this new device for weight loss. METHODS We conducted a search from 2016 to 2024 to assess the efficacy of the swallowable intragastric balloon for weight loss, including improvements in metabolic profiles and anthropometric measurements. Additionally, we evaluated potential adverse events related to the device to demonstrate its safety. RESULTS Eleven observational studies totalling 2107 patients were included, showing a reduction of 4.75 in BMI (95% CI: -5.02; -4.47), a mean total weight loss of 12.47% (95% CI: -13.77; -11.17), a mean excess weight loss of 48.04% (95% CI: -50.61; -45.48), and a rate of serious adverse events of 0.90%. An improvement in the metabolic profile was observed for three parameters: HDL, triglycerides, and glycaemia. CONCLUSION The swallowable liquid-filled intragastric balloon is safe and effective for managing weight loss within a four-month follow-up period.
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Affiliation(s)
- Adriana Fernandes Silva
- Gastrointestinal Endoscopy Service, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology,, Gastrointestinal Endoscopy Unit, Av. Dr. Enéas de Carvalho Aguiar, 255 Central Institute - Outpatient Building, Cerqueira César, São Paulo, SP, CEP: 05403-000, Brazil.
| | - Alexandre Moraes Bestetti
- Gastrointestinal Endoscopy Service, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Angelo So Taa Kum
- Gastrointestinal Endoscopy Service, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Beanie Conceição Medeiros Nunes
- Gastrointestinal Endoscopy Service, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Matheus de Oliveira Veras
- Gastrointestinal Endoscopy Service, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Wanderley Marques Bernardo
- Gastrointestinal Endoscopy Service, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Eduardo Guimarães Hourneaux de Moura
- Gastrointestinal Endoscopy Service, Hospital das Clínicas HCFMUSP, Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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288
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Zhou Y, Xie Y, Cai N, Liang Y, Gong R, Wang P. mm3DSNet: multi-scale and multi-feedforward self-attention 3D segmentation network for CT scans of hepatobiliary ducts. Med Biol Eng Comput 2024:10.1007/s11517-024-03183-z. [PMID: 39177918 DOI: 10.1007/s11517-024-03183-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 08/06/2024] [Indexed: 08/24/2024]
Abstract
Image segmentation is a key step of the 3D reconstruction of the hepatobiliary duct tree, which is significant for preoperative planning. In this paper, a novel 3D U-Net variant is designed for CT image segmentation of hepatobiliary ducts from the abdominal CT scans, which is composed of a 3D encoder-decoder and a 3D multi-feedforward self-attention module (MFSAM). To well sufficient semantic and spatial features with high inference speed, the 3D ConvNeXt block is designed as the 3D extension of the 2D ConvNeXt. To improve the ability of semantic feature extraction, the MFSAM is designed to transfer the semantic and spatial features at different scales from the encoder to the decoder. Also, to balance the losses for the voxels and the edges of the hepatobiliary ducts, a boundary-aware overlap cross-entropy loss is proposed by combining the cross-entropy loss, the Dice loss, and the boundary loss. Experimental results indicate that the proposed method is superior to some existing deep networks as well as the radiologist without rich experience in terms of CT segmentation of hepatobiliary ducts, with a segmentation performance of 76.54% Dice and 6.56 HD.
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Affiliation(s)
- Yinghong Zhou
- School of Information Engineering, Guangdong University of Technology, Guangzhou, 510006, China
| | - Yiying Xie
- School of Information Engineering, Guangdong University of Technology, Guangzhou, 510006, China
| | - Nian Cai
- School of Information Engineering, Guangdong University of Technology, Guangzhou, 510006, China.
| | - Yuchen Liang
- School of Information Engineering, Guangdong University of Technology, Guangzhou, 510006, China
| | - Ruifeng Gong
- School of Information Engineering, Guangdong University of Technology, Guangzhou, 510006, China
| | - Ping Wang
- Department of Hepatobiliary Surgery in the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China.
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289
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Ma Y, Yan Q, Wang P, Guo W, Yu L. Therapeutic potential of ghrelin/GOAT/GHSR system in gastrointestinal disorders. Front Nutr 2024; 11:1422431. [PMID: 39246401 PMCID: PMC11380557 DOI: 10.3389/fnut.2024.1422431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Ghrelin, a peptide primarily secreted in the stomach, acts via the growth hormone secretagogue receptor (GHSR). It regulates several physiological processes, such as feeding behavior, energy homeostasis, glucose and lipid metabolism, cardiovascular function, bone formation, stress response, and learning. GHSR exhibits significant expression within the central nervous system. However, numerous murine studies indicate that ghrelin is limited in its ability to enter the brain from the bloodstream and is primarily confined to specific regions, such as arcuate nucleus (ARC) and median eminence (ME). Nevertheless, the central ghrelin system plays an essential role in regulating feeding behavior. Furthermore, the role of vagal afferent fibers in regulating the functions of ghrelin remains a major topic of discussion among researchers. In recent times, numerous studies have elucidated the substantial therapeutic potential of ghrelin in most gastrointestinal (GI) diseases. This has led to the development of numerous pharmaceutical agents that target the ghrelin system, some of which are currently under examination in clinical trials. Furthermore, ghrelin is speculated to serve as a promising biomarker for GI tumors, which indicates its potential use in tumor grade and stage evaluation. This review presents a summary of recent findings in research conducted on both animals and humans, highlighting the therapeutic properties of ghrelin system in GI disorders.
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Affiliation(s)
- Yunxiao Ma
- Department of Endocrinology and Metabolism of First Hospital of Jilin University, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Qihui Yan
- Department of Endocrinology and Metabolism of First Hospital of Jilin University, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Ping Wang
- Department of Otolaryngology-Head and Neck Surgery of First Hospital of Jilin University, Jilin University, Changchun, China
| | - Weiying Guo
- Department of Endocrinology and Metabolism of First Hospital of Jilin University, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary Medicine, Jilin University, Changchun, China
| | - Lu Yu
- Department of Endocrinology and Metabolism of First Hospital of Jilin University, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research, Ministry of Education, Institute of Zoonosis, College of Veterinary Medicine, Jilin University, Changchun, China
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290
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Rombaldi MC, Barreto CG, Rombaldi RL, Costa EC, Holanda F, Cavazzola LT, Fraga JC. Barriers to diffusion and implementation of pediatric minimally invasive surgery in Brazil. BMC MEDICAL EDUCATION 2024; 24:906. [PMID: 39180085 PMCID: PMC11342547 DOI: 10.1186/s12909-024-05897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND The main barriers to the broad implementation of pediatric minimally invasive surgery (MIS) are technological, technical, and epistemological barriers, as well as the rarity of certain pathologies. These issues are presumed to be more significant in low- and middle-income countries. This study aimed to identify and analyze the factors limiting the diffusion and implementation of pediatric MIS in Brazil. METHODS A nationwide cross-sectional survey was conducted via an online questionnaire in Brazil from January 2022 to July 2022. The sample was taken by convenience from the population of pediatric surgeons in Brazil. A total of 187 surgeons were included. The collected data were divided into three sections to evaluate technological, technical, and epistemological limitations to pediatric MIS implementation. RESULTS Although 85% of the participants had previous training, a lack of adequate training was identified as a significant limiting factor, particularly among those who had taken only short courses (42.3% vs. 64.3%, p = 0.033). Only 14% of the participants reported performing MIS for major pediatric procedures. With respect to intracorporeal suturing, 38.1% of the surgeons with extensive training considered it a limiting factor compared with 60.7% (p = 0.029) of those without prior training. Among those without previous training, 61% cited a lack of financial support or encouragement from their department as the reason. Additionally, 65% of the surgeons considered the lack of basic instruments a limiting factor. Although 95% of the participants agreed that simulation training is indispensable, pediatric surgery fellowship programs in Brazil do not include a standardized curriculum or mandatory training in MIS, and only 47% reported providing training space for their current fellows. CONCLUSION A combination of technological, technical, and epistemological barriers hinders the implementation of pediatric MIS. Despite its limitations, this study serves as a foundational guide for future analysis and overcoming the identified barriers.
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Affiliation(s)
- Marcelo Costamilan Rombaldi
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
- Pediatric Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
| | | | | | - Eduardo Correa Costa
- Pediatric Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Felipe Holanda
- Pediatric Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Leandro Totti Cavazzola
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- General Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Jose Carlos Fraga
- Postgraduate Program in Medicine: Surgical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Pediatric Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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291
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Assi S, Hayar B, Pisano C, Darwiche N, Saad W. Novel ST1926 Nanoparticle Drug Formulation Enhances Drug Therapeutic Efficiency in Colorectal Cancer Xenografted Mice. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:1380. [PMID: 39269042 PMCID: PMC11396872 DOI: 10.3390/nano14171380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/15/2024]
Abstract
Cancer is a major public health problem that ranks as the second leading cause of death. Anti-cancer drug development presents with various hurdles faced throughout the process. Nanoparticle (NP) formulations have emerged as a promising strategy for enhancing drug delivery efficiency, improving stability, and reducing drug toxicity. Previous studies have shown that the adamantyl retinoid ST1926 displays potent anti-tumor activities in several types of tumors, particularly in colorectal cancer (CRC). However, phase I clinical trials in cancer patients using ST1926 are halted due to its low bioavailability. In this manuscript, we developed ST1926-NPs using flash nanoprecipitation with polystyrene-b-poly (ethyleneoxide) as an amphiphilic stabilizer and cholesterol as a co-stabilizer. Dynamic light scattering revealed that the resulting ST1926-NPs Contin diameter was 97 nm, with a polydispersity index of 0.206. Using cell viability, cell cycle analysis, and cell death assays, we showed that ST1926-NP exhibited potent anti-tumor activities in human CRC HCT116 cells. In a CRC xenograft model, mice treated with ST1926-NP exhibited significantly lowered tumor volumes compared to controls at low drug concentrations and enhanced the delivery of ST1926 to the tumors. These findings highlight the potential of ST1926-NPs in attenuating CRC tumor growth, facilitating its further development in clinical settings.
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Affiliation(s)
- Sara Assi
- Biomedical Engineering Program, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Berthe Hayar
- Department of Biochemistry & Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Claudio Pisano
- Biogem, Institute of Molecular Biology and Genetics, Via Camporeale, 83031 Ariano Irpino, AV, Italy
| | - Nadine Darwiche
- Department of Biochemistry & Molecular Genetics, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Walid Saad
- Department of Chemical Engineering and Advanced Energy, American University of Beirut, Beirut 1107 2020, Lebanon
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292
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Chobarporn T, Mesiri D, Tharavej C. Long-term outcomes of patients undergoing emergency surgery for corrosive injury of the upper digestive tract. Surg Today 2024:10.1007/s00595-024-02928-5. [PMID: 39177755 DOI: 10.1007/s00595-024-02928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
PURPOSE Emergency surgery can save patients' lives in cases of severe caustic injury. However, the long-term outcomes are not well understood. METHODS Patients who underwent emergency organ resection for severe corrosive acid injury were included. Subsequently, digestive tract reconstruction was performed to fit patients. Long-term outcomes were analyzed. RESULTS Fifty patients underwent emergency digestive tract resection. The operative mortality rate was 6% (of 3/50). One of the 50 patients underwent successful immediate reconstruction. Of the 46 survivors with digestive tract discontinuity, 32 (70%) underwent subsequent reconstructive surgery, 10 (22%) died while awaiting reconstruction due to deterioration in their psychiatric and nutritional status, and 4 (9%) were unfit for reconstructive surgery. No operative mortality occurred during reconstruction. Among the 32 patients who underwent reconstruction, 30 (94%) achieved nutritional autonomy. Nutritional independence was achieved in 62% of the patients (31/50). At a median duration of 58 months, the median survival time of the 50 patients was 158 months. Patients who underwent reconstruction had a significantly better overall survival than those who did not (p < 0.0001). CONCLUSIONS Emergency surgery remains the standard treatment for corrosive ingestion of complicated digestive tract injuries. However, only 60% of survivors can undergo subsequent digestive reconstruction and achieve long-term nutritional autonomy and a survival outcome.
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Affiliation(s)
- Thitiporn Chobarporn
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Dudsadee Mesiri
- Department of Surgery, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Chadin Tharavej
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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293
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Zhang S, Zhang X, Ren Y, Huang L, Xu W, Wang H, Lu Q. Regorafenib enhances the efficacy of photodynamic therapy in hepatocellular carcinoma through MAPK signaling pathway suppression. Photodiagnosis Photodyn Ther 2024; 49:104319. [PMID: 39181490 DOI: 10.1016/j.pdpdt.2024.104319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/10/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
Photodynamic therapy (PDT) is a promising and innovative approach for treating tumors. The synergistic effect of PDT and chemotherapy can enhance the anti-tumor efficacy by leveraging their complementing benefits. In this study, we created lipid vesicles to deliver a photosensitizer (chlorin e6, Ce6) and Regorafenib into tumors for the purpose of examining the effectiveness and mechanism of Lipo-Ce6@Rego-PDT (LCR-P) on Hepatocellular carcinoma (HCC) both in vitro and in vivo. We found that the cytotoxicity on HCC caused by LCR-P was significantly stronger than that caused by Lipo-Ce6-PDT (LC-P). Cellular ROS production in the LCR-P group was approximately higher than that in the LC-P group, and Regorafenib significantly inhibited the phosphorylation of JNK, ERK, and P38 of Lipo-Ce6-PDT group in vitro and in vivo. Furthermore, Regorafenib significantly downregulated the expression of Bcl-2 and upregulated the expression of Bax and cleaved caspase-3 of LC-P group in vitro and in vivo. Compared with LC-P, LCR-P significantly increased cell apoptosis rate. The body weight and HE staining of normal organs primarily indicated the safety of this combined strategy. These results indicate that the combination of Regorafenib and Lipo-Ce6 can significantly enhance the anti-tumor efficiency of PDT for HCC and exhibits good biosafety.
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Affiliation(s)
- Song Zhang
- Postdoctoral Research Station, General Hospital of Central Theater Command, Wuhan, Hubei 430070, China; Department of Gastroenterology, General Hospital of Central Theater Command, Wuhan, Hubei 430070, China; School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China
| | - Xiao Zhang
- Department of Gastroenterology, General Hospital of Central Theater Command, Wuhan, Hubei 430070, China; School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China
| | - Yali Ren
- Department of Gastroenterology, General Hospital of Central Theater Command, Wuhan, Hubei 430070, China; School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China
| | - Lu Huang
- Department of Gastroenterology, General Hospital of Central Theater Command, Wuhan, Hubei 430070, China; School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China
| | - Weitian Xu
- Department of Gastroenterology, General Hospital of Central Theater Command, Wuhan, Hubei 430070, China; School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei 430065, China
| | - Haiping Wang
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan 430056, China; Cancer Institute, School of Medicine, Jianghan University, Wuhan, China.
| | - Qiping Lu
- Postdoctoral Research Station, General Hospital of Central Theater Command, Wuhan, Hubei 430070, China.
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294
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Mehdi TM, Neirouz K, Souhir N, Souha B, Mohamed Ali C, Annouar O, Mehdi K, Ramzi N. Chicken bones: An etiology of a misleading clinical presentation of a rare case report of appendicular perforation. SAGE Open Med Case Rep 2024; 12:2050313X241275802. [PMID: 39185070 PMCID: PMC11342422 DOI: 10.1177/2050313x241275802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 07/22/2024] [Indexed: 08/27/2024] Open
Abstract
Foreign body (FB) ingestion leading to appendicular perforation, although rare in adults, presents a complex clinical challenge. The clinical presentation may not always be straightforward, necessitating a comprehensive array of diagnostic examinations. In fact, accurate and timely diagnosis is crucial to prevent severe complications. In this report, we present a case where a misleading clinical presentation led to the unexpected discovery of appendicular perforation during surgery, despite initial suspicion of small bowel perforation - a 77-year-old male patient who was edentulous and under follow-up for chronic bronchitis stage IV. He sought medical attention due to a 2-week history of right iliac fossa pain, during which he did not experience vomiting or fever. Upon physical examination, there was a tenderness noted in the sub umbilical region. An abdominal computed tomography (CT) scan was performed, revealing the presence of a dense FB which seems to be a bone located in the last ileal loop. Additionally, the appendix appeared slightly distended. Given the clinical presentation, which strongly indicated acute peritonitis resulting from small bowel perforation, and following consultation with gastroenterologists, it was decided that endoscopic retrieval was not suitable for this case. Therefore, a surgical approach was chosen, involving a midline incision, as laparoscopy was absolutely contraindicated because of patient's respiratory distress. Per-operatively, we identified a clear effusion, and within the wall of the appendix, we discovered a thin, sharp chicken bone that had become lodged, resulting in a phlegmonous and perforated appendix. The 2-cm bone was successfully removed, and an appendectomy was performed. The post-operative period was uneventful, and the patient was discharged on the fourth postoperative day. This case highlights the need for a high index of suspicion for atypical clinical presentations and the ongoing need for research to improve our understanding and management of this rare condition, ultimately enhancing patient outcomes.
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Affiliation(s)
| | - Kammoun Neirouz
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Nasseh Souhir
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Bhouri Souha
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Oueslati Annouar
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Khalfallah Mehdi
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Nouira Ramzi
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
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295
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Rosenbaum C, Gerds N, Hack L, Weitschies W. Scalability of API-Loaded Multifilament Yarn Production by Hot-Melt Extrusion and Evaluation of Fiber-Based Dosage Forms. Pharmaceutics 2024; 16:1103. [PMID: 39204448 PMCID: PMC11360357 DOI: 10.3390/pharmaceutics16081103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Revised: 08/09/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024] Open
Abstract
Fiber-based technologies are widely used in various industries, but their use in pharmaceuticals remains limited. While melt extrusion is a standard method for producing medical fibers such as sutures, it is rarely used for pharmaceutical fiber-based dosage forms. The EsoCap system is a notable exception, using a melt-extruded water-soluble filament as the drug release trigger mechanism. The challenge of producing drug-loaded fibers, particularly due to the use of spinning oils, and the processing of the fibers are addressed in this work using other approaches. The aim of this study was to develop processes for the production and processing of pharmaceutical fibers for targeted drug delivery. Fibers loaded with polyvinyl alcohol and fluorescein sodium as a model drug were successfully prepared by a continuous melt extrusion process and directly spun. These fibers exhibited uniform surface smoothness and consistent tensile strength. In addition, the fibers were further processed into tubular dosage forms using a modified knitting machine and demonstrated rapid drug release in a flow cell.
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Affiliation(s)
- Christoph Rosenbaum
- Department of Biopharmaceutics and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, Felix-Hausdorff-Straße 3, 17489 Greifswald, Germany
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296
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Li R, Zhu Y. Preoperative Hypoalbuminemia is Associated With Higher 30-day Mortality and Complications After Esophagectomy. Am Surg 2024:31348241278019. [PMID: 39172094 DOI: 10.1177/00031348241278019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND Serum albumin level is routinely screened during preoperative assessments as a biomarker for poor nutritional status and/or concurrent inflammation. In esophagectomy, while early postoperative hypoalbuminemia is associated with a higher risk of adverse surgical outcomes, the effects of preoperative hypoalbuminemia on esophagectomy outcomes were conflicting. This study aimed to examine the effect of preoperative hypoalbuminemia on 30-day outcomes following esophagectomy. METHODS National Surgical Quality Improvement Program (NSQIP) esophagectomy targeted database from 2016 to 2022 was used. Patients with preoperative serum albumin <3.4 g/L were defined as having hypoalbuminemia. Patients with and without hypoalbuminemia were propensity-score matched (1:3 ratio) for demographics, baseline characteristics, neoadjuvant therapy, surgical approaches, tumor diagnosis, and pathologic staging of the malignancy. Thirty-day postoperative outcomes were examined. RESULTS There were 803 (10.24%) and 7046 (89.76%) patients with and without preoperative hypoalbuminemia who underwent esophagectomy, respectively. After propensity-score matching, all patients with hypoalbuminemia were matched to 2170 controls. After propensity-matching, patients with hypoalbuminemia had higher risks of mortality (4.48% vs 3.00%, P = 0.04), sepsis (14.94% vs 10.92%, P < 0.01), and bleeding requiring transfusion (21.30% vs 13.50%, P < 0.01). Also, patients with hypoalbuminemia had a higher rate of discharge not to home (42.65% vs 34.81%, P < 0.01) and longer LOS (12.69 ± 9.09 vs 11.39 ± 8.16 days, P < 0.01). CONCLUSION Patients with preoperative hypoalbuminemia had increased risks of mortality and complications after esophagectomy. Thus, preoperative hypoalbuminemia could be a useful and cost-effective tool for preoperative risk stratification for patients undergoing esophagectomy, and correcting the underlying cause of hypoalbuminemia may help decrease the risk of adverse postoperative outcomes.
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Affiliation(s)
- Renxi Li
- The George Washington UniversitySchool of Medicine and Health Sciences, Washington, DC, USA
| | - Yueyao Zhu
- The University of Wisconsin-Madison, Madison, WI, USA
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297
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Katsura M, Ashbrook M, Ikenoue T, Takahashi K, Ito MA, Martin MJ, Inaba K, Matsushima K. Surgical trends and outcomes of open, laparoscopic, and robotic colostomy reversal for benign disease. Surgery 2024:S0039-6060(24)00548-8. [PMID: 39179435 DOI: 10.1016/j.surg.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/05/2024] [Accepted: 07/18/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Despite the increasing use of minimally invasive surgeries, the outcome benefits of adopting minimally invasive surgery for colostomy reversal remain unclear. We aimed to analyze nationwide trends in the use of minimally invasive surgery for colostomy reversal and compare patient outcomes between different surgical approaches. METHODS The National Inpatient Sample was queried for patients who underwent colostomy reversal for benign disease from 2015 to 2021. National trends in the use of minimally invasive surgery for colostomy reversal were analyzed by Cochran-Armitage tests. Multivariable linear and logistic regressions accounting for hospital sample weights were developed to examine the association between operative approach (open, laparoscopic, and robotic) and patient outcomes, including hospital complications, length of stay, and hospital charges. RESULTS A total of 23,260 patients underwent colostomy reversal: 18,880 (81.2%) open, 3,245 (14.0%) laparoscopic, and 1,135 (4.9%) robotic surgery. From 2015 to 2021, the proportion of robotic approaches increased >5-fold (range 2.1-12.5%; Ptrend < .001), whereas the increase in laparoscopic approaches was not significant (range 11.5-16.2%; Ptrend = .34). Multivariable analysis showed that the laparoscopic approach was associated with a lower incidence of pulmonary complications (adjusted odds ratio, 0.49; 95% confidence interval, 0.28-0.87), surgical-site infection (odds ratio, 0.37; 95% CI, 0.19-0.72), peritonitis/abdominal abscess (odds ratio, 0.45; 95% confidence interval, 0.26-0.78), and paralytic ileus (odds ratio, 0.67; 95% confidence interval, 0.48-0.92). The robotic approach was associated with a lower incidence of paralytic ileus (odds ratio, 0.58; 95% confidence interval, 0.33-0.99). Laparoscopic and robotic approaches were associated with 22.9% and 29.9% shorter length of stay, respectively. The robotic approach was associated with 33.0% greater hospital charge. CONCLUSIONS This study observed a significant trend toward the increased use of robotics in colostomy reversal and potential clinical benefits with minimally invasive surgery. Robotic colostomy reversal, along with laparoscopic approach, may provide better postoperative recovery compared with the open approach; however, the utility of robotic surgeries needs to be reevaluated in the future, given the limited clinical benefits despite greater hospital charges.
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Affiliation(s)
- Morihiro Katsura
- Department of Surgery, University of Southern California, Los Angeles, CA. https://twitter.com/hiro_m_bj8
| | - Matthew Ashbrook
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Tatsuyoshi Ikenoue
- Data Science and AI Innovation Research Promotion Centre, Shiga University, Hikone, Shiga, Japan
| | - Kyosuke Takahashi
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Masaki A Ito
- Department of Surgery, University of Southern California, Los Angeles, CA
| | - Matthew J Martin
- Department of Surgery, University of Southern California, Los Angeles, CA. https://twitter.com/docmartin22
| | - Kenji Inaba
- Department of Surgery, University of Southern California, Los Angeles, CA
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298
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Wu Z, Ge X, Shi D. ERAS and Gastrointestinal Site Infections: Insights from a Comprehensive Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2024. [PMID: 39172651 DOI: 10.1089/sur.2024.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
Background: Enhanced recovery after surgery (ERAS) protocols are proposed to enhance perioperative care, but their impact on various surgical outcomes requires further insight. Objective: This extensive meta-analysis aimed to systematically estimate the effectiveness of ERAS in reducing postoperative complications and improving recovery metrics. Materials and Methods: We meticulously searched multiple databases and rigorously screened studies, ultimately including 16 high-quality research articles in our meta-analysis. We carefully assessed heterogeneity using the Cochran Q test and I2 index. Results were visualized using forest plots, displaying effect sizes and 95% confidence intervals (CIs). Results: The current meta-analysis reveals compelling evidence of ERAS protocols' impact on postoperative effects. Lung infection rates were significantly reduced, with an odds ratio (OR) of 0.4393 (95% CI: 0.2674; 0.7216, p = 0.0012), highlighting the protocols' effectiveness. Although the reduction in surgical site infections (SSIs) was not significant, with an OR of 0.8003 (95% CI: 0.3908; 1.6389, p = 0.5425), the data suggests a trend toward benefit. Urinary tract infections (UTI) also showed a promising decrease, with an OR of 0.4754 (95% CI: 0.2028; 1.1143, p = 0.0871), revealing ERAS protocols may mitigate UTI risks. No significant effects were observed on postoperative anastomotic leakage or ileus, with ORs indicating neutrality. The incidence of readmission was similarly unaffected, with an OR of 1.4018 (95% CI: 0.6860; 2.8647, p = 0.3543). These outcomes underscore the selective efficacy of ERAS protocols, advocating for their strategic implementation to optimize surgical recovery. Conclusions: This meta-analysis offers compelling evidence supporting the implementation of ERAS in mitigating specific post-surgical conditions. It underscores the potential of ERAS to enhance recovery experiences and improve healthcare efficiency. Further targeted research is warranted to fully understand the impact of ERAS on SSI, anastomotic leakage, ileus, and readmissions and to optimize its benefits across diverse surgical populations.
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Affiliation(s)
- Zhiwei Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaofang Ge
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Dike Shi
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
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299
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Costa D, Ramai D, Tringali A. Novel classification of gastric polyps: The good, the bad and the ugly. World J Gastroenterol 2024; 30:3640-3653. [PMID: 39192997 PMCID: PMC11346164 DOI: 10.3748/wjg.v30.i31.3640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/19/2024] [Accepted: 08/02/2024] [Indexed: 08/13/2024] Open
Abstract
Gastric polyps (GPs) are increasingly common. On upper endoscopy, they should be examined with white light and occasionally chromoendoscopy, and their morphology classified according to the Paris classification. Most GPs have a typical endoscopic appearance and can be associated with diseases like Helicobacter pylori infection. Histological examination is necessary for an accurate diagnosis. While most polyps are non-neoplastic and do not require treatment, some carry a risk of malignancy or are already malignant. Therefore, understanding the diagnosis, classification, and management of GPs is crucial for patient prognostication. Our new classification categorizes GPs into "good", "bad", and "ugly" based on their likelihood of becoming malignant. We aim to provide descriptions of the endoscopic appearance, pathology, treatment, and follow-up for different GPs, as well as clinical management flowcharts.
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Affiliation(s)
- Deborah Costa
- Department of Digestive Endoscopy and Gastroenterology, AULSS2, Conegliano Hospital, Conegliano 31015, Italy
| | - Daryl Ramai
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Alberto Tringali
- Department of Digestive Endoscopy and Gastroenterology, AULSS2, Conegliano Hospital, Conegliano 31015, Italy
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300
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Zhang C, Fu Y, Li R, Wang J, Tang D, Ren J, Wang D, Zha W. Low ligation of the inferior mesenteric artery in robotic mid-low rectal cancer surgery: a comparative study from a single-center. J Robot Surg 2024; 18:325. [PMID: 39167152 DOI: 10.1007/s11701-024-02080-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 08/12/2024] [Indexed: 08/23/2024]
Abstract
Laparoscopic total mesorectal excision is the main surgical approach for treating rectal cancer, but there is still no clear consensus on the issue of low ligation of the inferior mesenteric artery during the procedure. Robotic surgery has been shown to have certain advantages over laparoscopic surgery in multiple studies, but further research is needed to better understand the outcomes of robotic surgery in the context of low ligation procedures. In this study, we included 1590 patients with mid-low rectal cancer. Among them, 942 patients underwent low ligation surgery (LL), divided into 138 in the robotic group and 804 in the laparoscopic group. The high ligation surgery (HL) group consisted of 648 patients. The results of LL vs HL showed that the LL group had faster bowel movement recovery (P = 0.003), lower anastomotic leak rate (P = 0.032), and lower International Prostate Symptom Score (IPSS) at 6 months postoperatively (P < 0.001). The results of Rob-LL vs Lap-LL showed that the Rob-LL group had longer operative time (P < 0.001), less blood loss (P = 0.001), more lymph nodes retrieved (P = 0.045), and lower Wexner score at 2 weeks postoperatively (P = 0.029). The concept of low ligation of the inferior mesenteric artery is a promising surgical approach that can accelerate the patient's functional recovery. When combined with robotic technology, it may offer more benefits than laparoscopic techniques.
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Affiliation(s)
- Chenkai Zhang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou, Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
| | - Yayan Fu
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou, Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
| | - Ruiqi Li
- Department of Gastrointestinal Surgery, Northern Jiangsu Peoples's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- Yangzhou, Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
- Nanjing University, Nanjing, 210093, China
| | - Jie Wang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou, Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, 225001, China
| | - Dong Tang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- Department of Gastrointestinal Surgery, Northern Jiangsu Peoples's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
| | - Jun Ren
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China
- Medical College of Yangzhou University, Yangzhou, 225001, China
- Department of Gastrointestinal Surgery, Northern Jiangsu Peoples's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
| | - Daorong Wang
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
- Medical College of Yangzhou University, Yangzhou, 225001, China.
- Department of Gastrointestinal Surgery, Northern Jiangsu Peoples's Hospital, No.98 Nantong West Road, Yangzhou, 225001, Jiangsu Province, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
| | - Wenzhang Zha
- Clinical Medical College, Yangzhou University, Yangzhou, 225001, China.
- Medical College of Yangzhou University, Yangzhou, 225001, China.
- Department of General Surgery, Yancheng City No.1 People's Hospital, Yancheng, 224005, Jiangsu Province, China.
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