Inflammatory response to surgical trauma in patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy: a randomised multicentre study

Effects of Serum From Radiofrequency Ablation Patients Receiving General Anesthesia or Local Anesthesia on Hepatocellular Carcinoma Cancer Cell Malignancy: A Prospective Randomized Controlled Trial

Background

Whether anesthesia methods affect malignant biological behavior of cancer remains unresolved. In this study, we aim to compare the effects of general anesthesia (GA) and local anesthesia (LA) on serum collected from primary hepatocellular carcinoma (HCC) patients presenting for radiofrequency ablation (RFA).

Methods

From August 2020 to December 2020, a prospective, randomized, and controlled study was conducted at Renji Hospital, which is affiliated with Shanghai Jiaotong University School of Medicine. 25 qualified patients from 18 to 65 years of age undergoing RFA were enrolled in the study and randomly assigned into two groups: the GA group (n = 14) and the LA group (n = 11). Venous blood was drawn from all patients preoperatively and 1 hour postoperatively. The serum collected was then used for the culturing of HepG2 cells. The malignant biological behaviors of HepG2 cells, including invasion, migration and proliferation, were observed after 24 hours of exposure to patients’ serum. ELISA was used to compare expression levels of pro-inflammatory cytokines (IL-1β, IL-6, TNF-α) and lymphokines (IFN-γ, IL-2) in patients’ serum from both groups.

Results

HepG2 cells cultured with postoperative serum obtained from patients who received GA, but not LA, were associated with significantly increased cell invasion, migration and proliferation, compared to preoperative serum from the same patient group. Expression levels of pro-inflammatory cytokines were significantly higher, and lymphokines significantly lower in postoperative serum from GA patients compared to the corresponding preoperative serum.

Conclusion

GA affects the serum milieu of patients with HCC, promoting the malignant biological behavior of a human HCC cell line.

Leucocyte Count Does Not Improve the Diagnostic Performance of a Diagnostic Score (DS) in Distinguishing Acute Appendicitis (AA) from Nonspecific Abdominal Pain (NSAP)

BACKGROUND/AIM

Although, acute appendicitis (AA) and nonspecific abdominal pain (NSAP) are the most common diagnoses among secondary care patients with acute abdominal pain, the diagnostic performance of leucocyte count (LC) in DS (Diagnostic Score) model is rarely considered.

PATIENTS AND METHODS

As an extension of the World Organisation of Gastro-Enterology Research Committee (OMGE) acute abdominal pain study, 1,333 patients presenting with acute abdominal pain were included in the study. The clinical history and diagnostic symptoms (n=22), signs (n=14) and tests (n=3) in each patient were recorded in detail, and the collected data were related with the final diagnoses of the patients.

RESULTS

In the ROC comparison test, there was no statistically significant difference in the performance of DS_LC- (DS without LC) and DS_LC+ (DS with LC). The highest sensitivities of the DS_LC- and DS_LC+ tests for detecting AA were 86% (95%CI=81-90%) and 87% (95%CI=82-91%), respectively. The highest specificities of the DS_LC- and DS_LC+ tests for detecting AA were 98% (95%CI=97-99%) and 98% (95%CI=96-99%), respectively.

CONCLUSION

DS could assist the clinician in differentiating AA from NSAP and other causes of acute abdominal pain. Importantly, LC does not improve the diagnostic performance of a DS in AA.

Gender-specific Performance of a Diagnostic Score in Acute Appendicitis

BACKGROUND/AIM

Although a negative appendectomy in female patients with acute abdominal pain (AAP) can be twice as frequent as in male patients, the accuracy of diagnostic scores (DSs) in acute appendicitis (AA) is rarely considered among patients with AAP. The aim was to study the gender-specific performance of a DS in AA.

PATIENTS AND METHODS

As an extension of the World Organisation of Gastro-Enterology Research Committee (OMGE) AAP study, 1,333 patients presenting with AAP were inclu ded in the study. The clinical history and diagnostic symptoms (n=22), signs (n=14) and laboratory tests (n=3) were recorded in each patient.

RESULTS

The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis, separately for both genders. The formulas were tested at 6 different cut-off levels to find the best diagnostic performance for AA in females and males. The highest specificities of the DS_LC- [DS without leucocyte count (LC)] and DS_LC+ (DS with LC) scores in detecting AA were 98% (95% CI=97-99%) and 98% (95% CI=96-99%), respectively. In the ROC comparison test, there was no statistically significant difference in the performance of DS_LC- and DS_LC+ in female and male patients.

CONCLUSION

Our gender-specific DS reached very high AUC values for AA (0.948-0.956) in both genders, and there was no statistically significant difference in the AUC values of DS_LC- and DS_LC+ between women and men with AAP.

The plasma 8-OHdG levels and oxidative stress following cholecystectomy: a randomised multicentre study of patients with minilaparotomy cholecystectomy versus laparoscopic cholecystectomy

OBJECTIVE

The aim of the study was to evaluate the role of 8-OHdG (8-hydroxy-2'-deoxyguanosine) detecting oxidative stress response following cholecystectomy in a randomised multicentre study of patients with minilaparotomy cholecystectomy (MC) versus laparoscopic cholecystectomy (LC).

METHODS

Initially, 106 patients with non-complicated symptomatic gallstone disease were randomised into MC (n = 56) or LC (n = 50) groups. Plasma levels of the oxidative stress marker 8-OHdG measured at three time points; before (PRE), immediately after (POP1) and 6 h after operation (POP2).

RESULTS

The demographic variables and the surgical data were similar in the study groups. The plasma oxidative stress marker 8-OHdG concentrations following surgery in the MC versus LC patients were quite similar. There was no significant correlation between the individual values of the11-point numeric rating pain scale (NRS) versus the plasma 8-OHdG post-operatively in the MC and LC patients. However, there was a statistically significant correlation between the individual values of the plasma 8-OHdG (PRE) versus IL-10 (PRE) for the MC and LC patients (r = 0.214, p = 0.037). There was also a statistically significant correlation between the individual values of the plasma 8-OHdG (POP2) versus IL-1β (POP2) for the MC and LC patients (r = 0.25, p = 0.01).

CONCLUSION

Our results suggest that the oxidative stress marker 8-OHdG concentrations following surgery in MC versus LC patients were quite similar. A new finding with possible clinical relevance is a correlation between the individual plasma values of the 8-OHdG versus anti-inflammatory interleukin IL-10 and 8-OHdG versus IL-1β (proinflammatory) in the MC and LC patients suggesting that inflammation and oxidative stress are related.