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Perivoliotis K, Tzovaras G, Tepetes K, Baloyiannis I. Comparison of intracorporeal and extracorporeal anastomosis in laparoscopic right colectomy: an updated meta-analysis and trial sequential analysis. Updates Surg 2024; 76:375-396. [PMID: 38216794 DOI: 10.1007/s13304-023-01737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
This meta-analysis was conducted to provide updated evidence regarding perioperative safety and efficacy, of IC and EC anastomosis in laparoscopic right colectomies. In this study, the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines were applied. The study protocol received a PROSPERO registration (CRD42020214596). A systematic literature search of the electronic scholar databases (Medline, Web of Science and Scopus) was performed. To reduce type I error, a trial sequential analysis (TSA) algorithm was introduced. The quality of evidence was evaluated based on the GRADE methodology. In total, 46 studies were included in this meta-analysis, Pooled comparisons and TSA confirmed that IC is superior in terms of incisional hernia (0.29; 95%CI: 0.19, 0.44), open conversion (0.45; 95%CI: 0.30, 0.67), reoperation (0.62; 95%CI: 0.46, 0.84]), LOS (- 0.76; 95%CI: - 1.03, - 0.49), blood loss (- 11.50; 95%CI: - 18.42, - 4.58), and cosmesis (- 1.71; 95%CI: - 2.01, - 1.42). Postoperative pain and return of bowel function were, also, shortened when the anastomosis was fashioned intracorporeally. The grading of most evidence ranged from 'low' to 'high'. Due to the discrepancy in the results of RCTs and non-RCTs, and the proportionally smaller sample size of the former, further randomized trials are required to increase the evidence of this comparison.
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Affiliation(s)
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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Ouyang R, Leng S, Chen L, Ma Y, Hu L, Sun A, Wang Q, Zhao X, Tan RS, Guo C, Yao X, Zhong L, Zhong Y. Assessment of right ventricular diastolic function in pediatric patients with repaired tetralogy of Fallot by cardiovascular magnetic resonance and echocardiography. Eur Radiol 2024:10.1007/s00330-023-10538-x. [PMID: 38180528 DOI: 10.1007/s00330-023-10538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Cardiovascular magnetic resonance (CMR) imaging is routinely performed for assessing right ventricular (RV) systolic but not diastolic function. We aimed to investigate CMR-based assessment of RV diastolic function in pediatric patients with repaired tetralogy of Fallot (rTOF), compared to transthoracic echocardiography (TTE) measurements. METHODS A total of 130 consecutive pediatric patients with rTOF who underwent clinically indicated CMR and same-day TTE were included. Forty-three controls were recruited. Phase-contrast images were used to measure trans-tricuspid valve flow velocities during early (E) and late diastolic (A) phases (measured in cm/s). Feature tracking of the tricuspid annulus was performed to derive early (e') and late diastolic (a') myocardial velocities (measured in cm/s). RV diastolic function was evaluated by E/A ratio, E/e' ratio, and E-wave deceleration time (measured in milliseconds). Regression analyses were utilized to identify potential variables associated with RV diastolic dysfunction (DD). The performance of CMR-derived parameters in diagnosing RV DD was assessed using receiver-operating characteristic analyses. RESULTS Good agreement was found between CMR and TTE measurements (ICC 0.70-0.89). Patients with RV DD (n = 67) showed significantly different CMR-derived parameters including E and e' velocities, and E/A and E/e' ratio, compared to patients without DD (n = 63) (all p < 0.05). CMR-derived E and e' velocities and E/e' ratio were independent predictors of RV DD. E/e' of 5.8 demonstrated the highest discrimination of RV DD (AUC 0.76, sensitivity 70%, specificity 86%). CONCLUSIONS CMR-derived parameters showed good agreement with TTE parameters in determining RV DD. CMR-derived E/e' was proved to be the most effective in identifying RV DD. CLINICAL RELEVANCE STATEMENT This study demonstrated the feasibility and efficacy of CMR in assessing diastolic function in pediatric patients. RV DD was presented in over half of patients according to current TTE guidelines, highlighting the need for assessing RV diastolic function during follow-up. KEY POINTS • Routinely acquired cine and phase-contrast cardiovascular magnetic resonance (CMR) images yielded right ventricular (RV) diastolic parameters which demonstrated good agreement with transthoracic echocardiography (TTE) measurements. • There was a high prevalence of RV diastolic function impairment in pediatric patients with repaired tetralogy of Fallot (rTOF). • CMR is a reliable complementary modality of TTE for RV diastolic function evaluation.
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Affiliation(s)
- Rongzhen Ouyang
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Shuang Leng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Lijun Chen
- Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Yanyan Ma
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Liwei Hu
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Aimin Sun
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Qian Wang
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Xiaodan Zhao
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore
| | - Chen Guo
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Xiaofen Yao
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China
| | - Liang Zhong
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Rd, Singapore, 169857, Singapore.
- Department of Biomedical Engineering, National University of Singapore, Engineering Drive 3 Block 4, Singapore, 117583, Singapore.
| | - Yumin Zhong
- Department of Radiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 1678 Dong Fang Rd, Shanghai, 200127, China.
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Petrelli F, Dottorini L, Luciani A. Prognostic relevance of sidedness in older patients with colon cancer: A review and pooled analysis of 227,218 patients. J Geriatr Oncol 2024; 15:101624. [PMID: 37696686 DOI: 10.1016/j.jgo.2023.101624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/16/2023] [Accepted: 08/31/2023] [Indexed: 09/13/2023]
Abstract
Age is a major risk factor for sporadic colon cancer (CC). In the general population, the side of the tumor (right versus left) shows a possible significant prognostic effect, with right tumors displaying the worst outcome due to biological differences. However, little is known about the role of sidedness in the older population. We conducted a pooled analysis of observational and prospective studies to confirm or reject the hypothesis that side is a prognostic variable, even in older patients with CC. Using the terms ("colorectal" or "colon") and ("cancer" or "carcinoma") and ("elderly" or "older" or "65 years" or "70 years" or "75 years") and ("side" or "site" or "right" or "left"), we searched PubMed, Embase, and the Cochrane Library through January 2023. We selected studies in the English language to compare the prognosis of left versus right CC in older patients (with a lower age limit of 65 years). The primary endpoint was overall survival (OS). Hazard ratios (HRs) for OS with relative 95% confidence intervals (CIs) were extracted from each study. Summary HRs were calculated using random- or fixed-effects models, depending on the heterogeneity of the included studies. The review process led to the inclusion of 13 articles. The studies reported the OS data for a total of 227,218 patients with CC. The CC side was not independently associated with mortality risk in older CC patients (HR 0.97; 95% CI 0.9-1.04; p = 0.34). High heterogeneity was observed in the main analysis (P < 0.01; I2 = 85%). In conclusion, our analysis shows that the tumor being on the left or right side in older patients with CC has no significant role in the risk of overall death. These data support the use of other parameters, such as stage, biology, comorbidities, and life expectancy, to decide on treatment and the prolongation of screenings until a patient's latest years.
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Bezad R, Omrani SE, Benbella A, Assarag B. Access to infertility care services towards Universal Health Coverage is a right and not an option. BMC Health Serv Res 2022; 22:1089. [PMID: 36008812 PMCID: PMC9414098 DOI: 10.1186/s12913-022-08456-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Background In Morocco, the national health plan 2025 was developed to promote Sexual and Reproductive Health (SRH) services for all. The principal aim was to achieve the Universal Health Coverage of SRH by 2030. For many years, health authorities’ efforts had focused on reducing maternal mortality through a widespread access to antenatal and obstetric care and family planning services. This has resulted in a significant gap between the availability of SRH components, namely obstetric and family planning care, and access to infertility services including Assisted Reproductive Technology (ART). The objective of this study is to answer two important questions. First, why some SRH programs and services are given priority by international and national political leaders while infertility care receives little attention; second, what are the factors that influence this prioritization? Methods We used Shiffman and Smith’s framework composed of four elements: the strength of the actors involved in the initiative, the power of the ideas they use to represent the health problem, the nature of the political contexts in which they operate and the characteristics of the services. We added a fifth element to the framework, the outcome. We applied this framework to the case of infertility services in Morocco. We conducted a desk review and interviews with actors involved in SRH and infertility care advocates as well as with decision makers involved in implementing Universal Health Coverage (UHC). Results Our results showed that despite the efforts made by the advocates of infertility care; the enactment in 2019 of a law regulating infertility care services; and the presence of two Assisted Reproductive Technology Units in the public sector, infertility services remain at an early stage of development hampered by multiple challenges. Among others, a lack of political entrepreneurs to ensure a strong leadership; the political windows were often missed; community members lacked consensus on a coherent public positioning of the problem, and advocates' perception and power of the idea lacked evidence and precise indicators of the problem. Conclusion To ensure the convergence and alignment of all stakeholders, it is recommended to translate the regulation of infertility into measurable activities with defined human and financial resources, equitable fertility health coverage, and quality fertility care to respond to women and infertile couples’ needs, rights and dignity.
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Affiliation(s)
- Rachid Bezad
- Obstetrics and Gynecology, Assisted Reproductive Technology Unit of the Reproductive Health Center, University Hospital Ibn Sina, Rabat, Morocco. .,Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco.
| | - Sanae El Omrani
- Maternal and Neonatal Health, University Ibn Tofail, Kenitra, Morocco.,The Association Together for Reproductive Health (ESR), Rabat, Morocco
| | - Amal Benbella
- Obstetrics and Gynecology, Assisted Reproductive Technology Unit of the Reproductive Health Center, University Hospital Ibn Sina, Rabat, Morocco.,Faculty of Medicine and Pharmacy, University Mohamed V, Rabat, Morocco
| | - Bouchra Assarag
- The Association Together for Reproductive Health (ESR), National School of Public Health, Rabat, Morocco
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Nguyen HH, Nguyen TK, Le VD, Luong TH, Dang KK, Nguyen VQ, Trinh HS. Isolated complete caudate lobectomy with Glissonean pedicle isolation using Takasaki's technique and right-left approach: preliminary experience from two case reports. World J Surg Oncol 2022; 20:31. [PMID: 35115011 PMCID: PMC8815180 DOI: 10.1186/s12957-022-02496-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/23/2022] [Indexed: 12/20/2022] Open
Abstract
Background Tumors located in the caudate lobe may be primary tumor or metastases from other sites. Isolated caudate lobectomy (ICL) is a challenging procedure due to its complex structure and location. The access route to the caudate lobe has an important role in the success of the operation. Methods Based on the characteristics of the segment I location, which is the part of the liver located in front of the vena cava, below the hepatic veins, and cranial to the hilar plate, our approach aims to isolate the entire caudate lobe from these anatomical structures with the following steps: dissecting the caudate lobe from the hilar plate and isolating the caudate lobe from the IVC and from the hepatic veins along with parenchymal resection. Results We report two successful cases with the Glissonean pedicle transection method described by Takasaki and the combined right- and left-side approach: a 63-year-old female patient with a 46-mm-in-diameter HCC tumor and a 39-year-old female patient with a 45-mm lesion and the pathological result was focal nodular hyperplasia. Conclusions We found this to be a safe and effective approach, which can be applied to all cases of benign tumors or in the case of malignant tumors located entirely in the caudate lobe when extended hepatic resection is not possible due to poor liver function or small remnant liver volume.
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Affiliation(s)
- Ham Hoi Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Thanh Khiem Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Van Duy Le
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Tuan Hiep Luong
- Department of Surgery, Hanoi Medical University, 1st Ton That Tung Street, Dong Da, Hanoi, 11521, Vietnam.
| | - Kim Khue Dang
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Vu Quang Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Hong Son Trinh
- Department of Oncology, Viet Duc University Hospital, Hanoi, Vietnam
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Roller FC, Schüssler A, Hasse A, Kriechbaum S, Richter M, Guth S, Tello K, Breithecker A, Liebetrau C, Hamm CW, Mayer E, Seeger W, Krombach GA, Wiedenroth CB. Effects of BPA on right ventricular mechanical dysfunction in patients with inoperable CTEPH - A cardiac magnetic resonance study. Eur J Radiol 2021; 147:110111. [PMID: 34952330 DOI: 10.1016/j.ejrad.2021.110111] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of this study was to assess effects of balloon pulmonary angioplasty (BPA) on right ventricular (RV) mechanical dysfunction in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) via MRI. METHOD MRI at 1.5 Tesla and right heart catheterization were performed before and 6 months after BPA in 30 CTEPH patients (mean age 63.4 ± 10.6 years; 17 female). Feature-tracking strain analysis, including global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain, was performed and compared with right ventricular function, myocardial remodelling (assessed by native T1 times), and pulmonary haemodynamics (mean pulmonary arterial pressure and pulmonary vascular resistance). RESULTS RVEF (35.9% to 48.4%) increased and mPAP (42.1 mmHg to 33.1 mmHg) and PVR (551.8 to 377.7 dyn∙s/cm5) decreased after BPA (all p < 0.0001). Moreover, RV strain increased (GLS -19.9 to -24.0%, p = 0.0003; GCS -9.4 to -11.0%, p = 0.0022; GRS 38.2 to 50.7%, p = 0.001) and septal native area-adjusted T1 time (AA-T1) decreased (1019.4 to 988.7 ms, p < 0.0001). GLS revealed the best correlations with RVEF (before BPA r = -0.75; after BPA r = -0.54), mPAP (r = 0.36; r = 0.52), PVR (r = 0.49; r = 0.48), and AA-T1 (r = 0.44; 0.19). CONCLUSION RV mechanical dysfunction, pulmonary haemodynamics, and myocardial remodelling are markedly improved by BPA. Moreover, RV strain values showed good correlations with RV function, pulmonary haemodynamics, and myocardial remodelling. Therefore, strain analysis might provide new insights regarding therapy outcome, monitoring, and prognosis.
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Affiliation(s)
- Fritz C Roller
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany.
| | - Armin Schüssler
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Alexander Hasse
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | | | - Manuel Richter
- Department of Internal Medicine, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Stefan Guth
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Khodr Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Andreas Breithecker
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany
| | | | - Christian W Hamm
- Department of Cardiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany; Department of Cardiology, Campus Kerckhoff, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, Frankfurt am Main, Germany
| | - Eckhard Mayer
- Department of Thoracic Surgery, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | - Werner Seeger
- Department of Internal Medicine, Justus-Liebig-University Giessen, Klinikstraße 33, Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
| | - Gabriele A Krombach
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus-Liebig-University Giessen, Klinikstraße 33, 35392 Giessen, Germany; Member of the German Center for Lung Research, Giessen, Germany
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Davila Dupont D, Motola Kuba D, Alcantara Velarde TDLM, Martinez Castaneda EA, Dorantes Heredia R, Ruiz Morales JM. Impact of Testicular Germ Cell Tumor Laterality on Recurrence-Free Survival in the Mexican Population. World J Oncol 2021; 12:173-177. [PMID: 34804280 PMCID: PMC8577600 DOI: 10.14740/wjon1404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background To date, the prognostic value of laterality for testicular germ cell tumors remains unknown. Herein, we describe this prognostic factor in the Mexican population. Methods A retrospective single-center study that included 37 patients with primary testicular germ cell tumors was conducted. Primary outcome was recurrence-free survival (RFS) at 2 years. Secondary outcomes were RFS by histology, progression-free survival by laterality, and 2-year overall survival. Results Thirty-seven patients were included, of which five showed relapses. By laterality, the 2-year RFS rate was 100% for left tumors and 77.3% for right tumors, with a trend toward statistical significance (P = 0.058). By histology, the RFS rate was higher for seminomas than non-seminomas (89% vs. 83%, respectively) without this difference being statistically significant. Progression-free survival was higher for right tumors than left tumors (91% vs. 80%, respectively) but without reaching statistical significance. The overall survival rate for the entire cohort was 94.5%. Conclusions Our study shows that patients with primary germ cell tumors of the right testicle have a higher risk of recurrence than those with primary germ cell tumors of the left testicle, with a trend toward statistical significance.
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Chen CC, Chen CP, Yao PC. Surgical resection for huge recurrent right colon carcinoma after cetuximab plus FOLFIRI. Asian J Surg 2021; 44:1310-1311. [PMID: 34330592 DOI: 10.1016/j.asjsur.2021.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- Chou-Chen Chen
- Department of Surgery, Division of Colorectal,Taichung Veterans General Hospital, Taichung City, 40705, Taiwan; Department of Environmental Engineering, Dayeh University, Changhua County, 51591, Taiwan.
| | - Chou-Pin Chen
- Department of Surgery, Division of Colorectal,Taichung Veterans General Hospital, Taichung City, 40705, Taiwan.
| | - Pin-Chuan Yao
- Department of Environmental Engineering, Dayeh University, Changhua County, 51591, Taiwan.
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Magistro C, Bertoglio CL, Giani A, Mazzola M, Rubicondo C, Maspero M, Carnevali P, Origi M, Ferrari G. Laparoscopic complete mesocolic excision versus conventional resection for right-sided colon cancer: a propensity score matching analysis of short-term outcomes. Surg Endosc 2021. [PMID: 34129088 DOI: 10.1007/s00464-021-08601-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/06/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) for right-sided colon cancer (RCC) is a demanding operation, especially when performed laparoscopically. The potential impact of CME in increasing postoperative complications is still unclear. The aim of our study was to evaluate the safety and feasibility of laparoscopic CME compared with laparoscopic non-complete mesocolic excision (NCME) during colectomy for RCC. METHODS Data from a prospectively collected database of patients who underwent laparoscopic right and extended right colectomy at our institution between January 2008 and February 2020 were retrieved and analyzed. Short-term outcomes of patients undergoing CME and NCME were compared. A 1:1 propensity score matching (PSM) was used to balance baseline characteristics between groups. RESULTS A total of 663 consecutive patients underwent resection of RCC in the study period. Among these, 500 met the inclusion criteria and after PSM a total of 372 patients were correctly matched, 186 in each group. A similar rate of overall postoperative complications was found between the CME and NCME groups (21.5% and 18.3%, p = 0.436). No difference was found in terms of conversion rate, severe complications, reoperations, readmissions, and mortality. The median number of harvested lymph nodes was higher in the CME group (22 versus 19, p = 0.003), with a lower rate of inadequate sampling (7.0% and 15.1%, p = 0.013). CONCLUSION Laparoscopic CME for RCC is technically feasible and safe. It does not seem to be associated with a higher rate of complications or mortality compared with the "traditional" approach, but it allows better nodal sampling.
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Genedi AMM, Elzayat AM, Mohamed MM, Elmenshawy MD. Study of correlation between 2D echocardiographic assessment of right ventricle and outcome of acute heart failure patients. Heliyon 2021; 7:e06807. [PMID: 33948519 PMCID: PMC8080040 DOI: 10.1016/j.heliyon.2021.e06807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/12/2020] [Accepted: 04/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background Hospital length of stay (LOS) is a key determinant of heart failure hospitalization costs and performance of medical care quality. Right ventricular (RV) dysfunction predicted poor outcome in patients with acute heart failure (AHF). Aim To study the effect of right ventricular function on length of hospital stay as a predictor in patients with acute heart failure. Methods A prospective cohort study was conducted in Cardiology Care Units (CCUs) in Zagazig University Hospital and Shark El Madina Hospital from September 2019 to February 2020, we included in this study 99 patients admitted with AHF. Clinical data and baseline RV function assessed by tricuspid annular plane systolic excursion (TAPSE) and S' velocity were collected. Clinical comorbidities including worsening renal function (WRF) were monitored during hospitalization. The primary outcome was hospital LOS. Results There was statistically significant correlation between WRF, right ventricular systolic dysfunction identified by TAPSE<16 mm and S' <9.5 cm/s and poor outcome in patients with acute heart failure including prolonged LOS. Conclusion Right ventricular (RV) systolic dysfunction as assessed by TAPSE and S' velocity and diastolic dysfunction were independent predictors of longer LOS in AHF patients. WRF had high prevalence among patients with AHF and associated with poor outcome in AHF patients and prolonged LOS.
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Zuo K, Wang C, Wang J, Xia FF, Song T. Transjugular intrahepatic portosystemic shunt through left branch versus right branch of portal vein: a meta-analysis. Abdom Radiol (NY) 2021; 46:1718-25. [PMID: 33009924 DOI: 10.1007/s00261-020-02789-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/11/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the clinical outcomes between patients that underwent transjugular intrahepatic portosystemic shunt (TIPS) via the left and right portal veins (PVs). MATERIALS AND METHODS All relevant studies in the Pubmed, Embase, and Cochrane Library databases published as of June 2020 were identified by searching, after which RevMan v5.3 was used to conduct the present meta-analysis. Relevant endpoint data were extracted from each study, related to postoperative hepatic encephalopathy (HE) rates, TIPS dysfunction, re-bleeding, and mortality. RESULTS A total of eight studies were identified as being relevant for inclusion in this meta-analysis. These studies included 2592 total patients suffering from liver cirrhosis that underwent TIPS treatment via the left (n = 1500) or right (n = 1092) PVs. Rates of postoperative HE were significantly lower in the left PV group relative to the right PV group (5.7% vs. 18.1%, OR 0.19; P < 0.00001), as were rates of TIPS dysfunction (8.1% vs. 16.5%, OR 0.41; P < 0.00001). In contrast, the rates of re-bleeding did not differ significantly between these groups (12.0% vs. 14.9%, OR 0.76; P = 0.11), nor did mortality rates (30.9% vs. 31.0%, OR 0.85, P = 0.22). We did not detect any significant heterogeneity among included studies for any analyzed endpoints, nor was any risk of publication bias pertaining to these studies detected through the use of funnel plots. CONCLUSIONS TIPS conducted via the left PV was associated with decreased rates of postoperative HE and TIPS dysfunction relative to TIPS conducted via the right PV.
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See KC. Acute cor pulmonale in patients with acute respiratory distress syndrome: A comprehensive review. World J Crit Care Med 2021; 10:35-42. [PMID: 33728264 PMCID: PMC7941786 DOI: 10.5492/wjccm.v10.i2.35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/01/2021] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS)-related acute cor pulmonale (ACP) is found in 8%-50% of all patients with ARDS, and is associated with adverse hemodynamic and survival outcomes. ARDS-related ACP is an echocardiographic diagnosis marked by combined right ventricular dilatation and septal dyskinesia, which connote simultaneous diastolic (volume) and systolic (pressure) overload respectively. Risk factors include pneumonia, hypercapnia, hypoxemia, high airway pressures and concomitant pulmonary disease. Current evidence suggests that ARDS-related ACP is amenable to multimodal treatments including ventilator adjustment (aiming for arterial partial pressure of carbon dioxide < 60 mmHg, plateau pressure < 27 cmH2O, driving pressure < 17 cmH2O), prone positioning, fluid balance optimization and pharmacotherapy. Further research is required to elucidate the optimal frequency and duration of routine bedside echocardiography screening for ARDS-related ACP, to more clearly delineate the diagnostic role of transthoracic echocardiography relative to transesophageal echocardiography, and to validate current and novel therapies.
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Affiliation(s)
- Kay Choong See
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
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13
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Ghandour R, Ejbeh S, Maalouf P, Sayegh F, El Masri S, El Assaad H, Moussa E, Adaimi F. Never seen right gastrothorax: A case report. Trauma Case Rep 2020; 28:100316. [PMID: 32637533 DOI: 10.1016/j.tcr.2020.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2020] [Indexed: 11/20/2022] Open
Abstract
Traumatic gastrothorax, or stomach herniation into the chest post-trauma, is a rare but dangerous condition that can lead to respiratory distress and obstructive shock. Its diagnosis is challenging and requires a high index of suspicion. Immediate stomach decompression is an important, often life-saving step of the treatment, prior to definitive surgical repair. We report herein the case of a 59 year-old female patient, who was involved in a severe motor vehicle accident resulting in multiple injuries. Her right-sided gastrothorax, manifesting as solely nausea at first, was only diagnosed 16 days after trauma, intraoperatively. Worse, her herniated stomach had ruptured within the right pleural cavity causing pneumothorax, spillage of contents and pleuritis. It was an erroneous radiological diagnosis of right lung necrosis which halted surgical management. Right gastrothorax has never been reported previously. This article also reviews the condition's pathophysiology, along with diagnostic and therapeutic modalities, and sheds light on the importance of its early recognition and treatment.
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14
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Schickhardt C, Fleischer H, Winkler EC. Do patients and research subjects have a right to receive their genomic raw data? An ethical and legal analysis. BMC Med Ethics 2020; 21:7. [PMID: 31948449 PMCID: PMC6966790 DOI: 10.1186/s12910-020-0446-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/02/2020] [Indexed: 11/27/2022] Open
Abstract
Background As Next Generation Sequencing technologies are increasingly implemented in biomedical research and (translational) care, the number of study participants and patients who ask for release of their genomic raw data is set to increase. This raises the question whether research participants and patients have a legal and moral right to receive their genomic raw data and, if so, how this right should be implemented into practice. Methods In a first step we clarify some central concepts such as “raw data”; in a second step we sketch the international legal framework. The third step provides an extensive ethical analysis which comprehends two parts: an evaluation of whether there is a prima facie moral right to receive one’s raw data, and a contextualization and discussion of the right in light of potentially conflicting interests and rights of the data subject herself and third parties; in a last fourth step we emphasize the main practical consequences of the ethical analyses and propose recommendations for the release of raw data. Results In several legislations like the new European General Data Protection Regulation, patients do in principle have the right to receive their raw data. However, the procedural implementation of this right and whether it involves genetic counselling is at the discretion of the Member States. Even more questions remain with respect to the research context. The ethical analysis suggests that patients and research subjects have a moral right to receive their genomic raw data and addresses aspects which are also of relevance for the legal discussion such as the costs of release of raw data and its impact on academic freedom. Conclusion Taking into account the specific nature and implications of genomic raw data and the contexts of research and health care, several concerns and potentially conflicting interests of the data subjects themselves and involved researchers, physicians, biomedical institutions and relatives arise. Instead of using them to argue in favor of restrictions of the data subjects’ legal and moral right to genomic raw data, the concerns should be addressed through provision of information and other measures. To this end, we propose relevant recommendations.
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Affiliation(s)
- Christoph Schickhardt
- National Center for Tumor Diseases (NCT), Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Henrike Fleischer
- Institute for German, European and International Medical Law, Public Health Law and Bioethics (IMGB), Universities of Heidelberg and Mannheim, Mannheim, Germany
| | - Eva C Winkler
- National Center for Tumor Diseases (NCT), Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany.
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15
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Silva GVRD, Miana LA, Caneo LF, Turquetto ALR, Tanamati C, Penha JG, Jatene FB, Jatene MB. Early and Long-Term Outcomes of Surgical Treatment of Ebstein's Anomaly. Braz J Cardiovasc Surg 2019; 34:511-516. [PMID: 31364344 PMCID: PMC6852467 DOI: 10.21470/1678-9741-2018-0333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate Ebstein's anomaly surgical correction and its early and long-term outcomes. METHODS A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein's anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. RESULTS Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients' mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. CONCLUSION In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.
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Affiliation(s)
- Guilherme Viotto Rodrigues da Silva
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Leonardo Augusto Miana
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Fernando Caneo
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Aída Luiza Ribeiro Turquetto
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Carla Tanamati
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Juliano G Penha
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio B Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Marcelo B Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Barthélémy R, Roy X, Javanainen T, Mebazaa A, Chousterman BG. Comparison of echocardiographic indices of right ventricular systolic function and ejection fraction obtained with continuous thermodilution in critically ill patients. Crit Care 2019; 23:312. [PMID: 31519203 PMCID: PMC6743193 DOI: 10.1186/s13054-019-2582-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/27/2019] [Indexed: 02/06/2023]
Abstract
Background Though echocardiographic evaluation assesses the right ventricular systolic function, which of the existing parameters best reflects the right ventricular ejection fraction (RVEF) in the critically ill patients is still uncertain. We aimed to determine the relationship between echocardiographic indices of right ventricular systolic function and RVEF. Methods Prospective observational study was conducted in a mixed Surgical Intensive Care Unit (Hôpital Lariboisière, Paris, France) from November 2017 to November 2018. All critically ill patients monitored with a pulmonary artery catheter were assessed. We collected echocardiographic indices of right ventricular function (tricuspid annular plane systolic excursion, TAPSE; peak systolic velocity of pulsed tissue Doppler at lateral tricuspid annulus, S′; fractional area change, FAC; right ventricular index of myocardial performance, RIMP; isovolumic acceleration, IVA; end-diastolic diameter ratio, EDDr) and compared them with the RVEF obtained from continuous volumetric pulmonary artery catheter. Results Twenty-five patients were analyzed. Admission diagnosis was acute heart failure in 11 patients and septic shock in 14 patients. Median age was 70 years [57–80], norepinephrine median dose was 0.29 μg/kg/min [0.14–0.50], median Sequential Organ Failure Assessment score was 12 [10–14], and mortality at day 28 was 56%. When compared to RVEF, TAPSE had the highest correlation coefficient (rho = 0.78, 95% CI 0.52 to 0.89, p < 0.001). S′ was also correlated to RVEF (rho = 0.64, 95% CI 0.60 to 0.80, p = 0.001) whereas FAC, RIMP, IVA, and EDDr did not. TAPSE lower than 16 mm, S′ lower than 11 cm/s, and EDDr higher than 1 were always associated with a reduced RVEF. Conclusions We found that amongst indices of right ventricular systolic function, TAPSE and S′ were well correlated with thermodilution-derived RVEF in critically ill patients. Electronic supplementary material The online version of this article (10.1186/s13054-019-2582-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Romain Barthélémy
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France. .,Réanimation Chirurgical Polyvalente, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
| | - Xavier Roy
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France
| | - Tujia Javanainen
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France
| | - Alexandre Mebazaa
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France.,Université de Paris, Paris, France
| | - Benjamin Glenn Chousterman
- Department of Anaesthesia and Critical Care, Lariboisière Hospital, DMU Parabol, APHP.Nord, Paris, France.,Inserm UMR-S942, Mascot, Paris, France.,Université de Paris, Paris, France
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Lee JM, Han YD, Cho MS, Hur H, Min BS, Lee KY, Kim NK. Impact of tumor sidedness on survival and recurrence patterns in colon cancer patients. Ann Surg Treat Res 2019; 96:296-304. [PMID: 31183334 PMCID: PMC6543053 DOI: 10.4174/astr.2019.96.6.296] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/15/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
Purpose Previous studies have reported conflicting results regarding the prognostic value of tumor sidedness in colon cancer. We investigated the oncologic impact of tumor location and examined whether recurrence patterns were related to tumor sidedness in colon cancer patients. Methods We identified stage I-III colon adenocarcinoma patients from a prospective colorectal cancer registry at Severance Hospital, Seoul, Korea, who underwent complete mesocolic excision between 2005 and 2012. Adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for predictors of cancer-specific survival (CSS), recurrence-free survival (RFS), and cumulative recurrence at specific anatomic sites were examined using Cox proportional hazard regression analysis. Results Overall, 1,912 patients, 1,077 (56.3%) with left-sided colon cancer (LCC), and 835 (43.7%) with right-sided colon cancer (RCC), at a median follow-up of 59 months, were eligible and included in the study. In univariate analysis, similar 5-year CSS and RFS were observed for LCC and RCC in the total patient population, and when stratified by stage for stage I and II patients. For stage III patients, an adjusted Cox regression analysis indicated that RCC patients had a higher risk of cancer-specific mortality (HR, 1.75; 95% CI, 1.07-2.86; P = 0.024) and recurrence (HR, 1.78; 95% CI, 1.22-2.60; P = 0.003). Furthermore, RCC was an independent predictor of peritoneal recurrence (HR, 1.86; 95% CI, 1.05-3.29; P = 0.031) in stage III patients. Conclusion RCC correlated with worse CSS and RFS than LCC. In stage III patients, RCC correlated with increased risk of peritoneal recurrence. The reasons for these differences remain to be investigated.
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Affiliation(s)
- Jong Min Lee
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Dae Han
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Cho
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Soh Min
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Young Lee
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Bo M, Zotti CM, Charrier L. The no correlation argument: can the morality of conscientious objection be empirically supported? the Italian case. BMC Med Ethics 2017; 18:64. [PMID: 29157253 PMCID: PMC5696742 DOI: 10.1186/s12910-017-0221-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background The legitimacy of conscientious objection to abortion continues to fuel heated debate in Italy. In two recent decisions, the European Committee for Social Rights underlined that conscientious objection places safe, legal, and accessible care and services out of reach for most Italian women and that the measures that Italy has adopted to guarantee free access to abortion services are inadequate. Nevertheless, the Ministry of Health states that current Italian legislation, if appropriately applied, accommodates both the right to conscientious objection and the right to voluntary abortion. Main body One empirical argument used to demonstrate that conscientious objection does not create barriers to abortion is the “no correlation” argument, which the Italian Committee for Bioethics employed to demonstrate that no association exists between conscientious objection and waiting times for voluntary abortion in Italy and to support the weak form of conventional comprise adopted by the Italian legislation to balance the conflict between women’ autonomy and healthcare professionals’ moral integrity. Conversely, we showed how the “no correlation” argument fails to demonstrate the absence of a relationship between the number of conscientious objectors and waiting times for voluntary abortion, and that the limitations of the “no correlation” argument itself demonstrate how it is still difficult to describe the real effect of conscientious objection on the access to abortion services and to evaluate the suitability of conventional compromise to effectively balance conflicting moral principles. Conclusion Further studies are needed to better describe the relationship between conscientious objection and waiting times for voluntary abortion. If new evidence would show that the increasing proportion of objectors does undermine the efficacy of the Italian law and the right of a woman to freely obtain a voluntary abortion, new ways will need to be found to address the conflict between moral principles and restrict the protection accorded to the principle of moral integrity. This would inevitably imply the need to constrain and to redefine the terms and conditions for claiming conscientious objection.
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Affiliation(s)
- Marco Bo
- Research Group in Bioethics, University of Turin, Turin, Italy.,Consulta di Bioetica onlus, Turin, Italy
| | - Carla Maria Zotti
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Torino, Italy.
| | - Lorena Charrier
- Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126, Torino, Italy
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Takx RAP, Henzler T, Schoepf UJ, Germann T, Schoenberg SO, Shirinova A, Bauer RW, Frellesen C, Zhang LJ, Nance JW, Fink C, Apfaltrer P. Predictive value of perfusion defects on dual energy CTA in the absence of thromboembolic clots. J Cardiovasc Comput Tomogr 2017; 11:183-187. [PMID: 28431860 DOI: 10.1016/j.jcct.2017.04.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 04/05/2017] [Accepted: 04/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND To determine the predictive value of volumetrically measured lung perfusion defects (PDvol) and right ventricular dysfunction on dual-energy computed tomography angiography (DE-CTA) for predicting all cause mortality in patients suspected of pulmonary embolism (PE) but without evident thromboembolic clot on CTA. METHODS 448 patients underwent DE-CTA on a 64-channel DSCT system between January 2007 and December 2012 for suspected PE, of which 115 were without detectable thromboembolic clot on CTA. Diagnostic performance for identifying patients at risk of dying was evaluated using ROC analysis. All-cause mortality was assessed via the hospital electronic medical records and/or consultation of the patient or the patient's primary care physician via phone call interviews. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and area under the curve (AUC) were determined for PDvol (volume of perfusion defects/total lung volume), transverse right ventricular to left ventricular diameter ratios (RV/LV) and for the combination of both tests. RESULTS Mortality was 38% within the investigated time period of 6 months. Patients who died had significantly higher PDvol (PDvol 28 ± 13% vs. 19 ± 12%, p < 0.001) and a non-significant difference in transverse RV/LV ratio (1.14 ± 0.37 vs. 1.06 ± 0.22, p = 0.159). The AUC was 0.71 for PDvol, 0.53 for RV/LV ratio, and 0.67 for the combination of PDvol and RV/LV ratio. PDvol remained a significant predictor after correcting for age. CONCLUSIONS In the absence of thromboembolic clots, PDvol at DE-CTA appears to be predictive for all cause mortality.
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Affiliation(s)
- Richard A P Takx
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Henzler
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States.
| | - Thomas Germann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Aysel Shirinova
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ralf W Bauer
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany; Clinic of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, Switzerland
| | - Claudia Frellesen
- Department of Diagnostic and Interventional Radiology, Clinic of the Goethe University, Frankfurt, Germany
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - John W Nance
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Christian Fink
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Radiology, General Hospital Celle, Celle, Germany
| | - Paul Apfaltrer
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
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Isoda S, Imoto K, Uchida K, Karube N, Kasama K, Yamazaki I, Suzuki S, Yano Y, Matsuki Y, Masuda M. Pitfalls for the "Sandwich technique" via a right ventricular incision to repair post-infarction ventricular septal defects. Gen Thorac Cardiovasc Surg 2016; 65:187-193. [PMID: 27744610 DOI: 10.1007/s11748-016-0722-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND We have reported "sandwich technique," via a right ventricular incision, to treat a post-infarction ventricular septal defect (VSD). This technique involves the placement of patches on both the left and right sides of the septum, pinching the VSD sealed with surgical adhesive between the two patches. In this study, we analyzed factors influencing 1-year mortality to determine the pitfalls in our procedure. METHODS We evaluated 24 consecutive patients with post-infarction VSD who underwent the "sandwich technique" via a right ventricular incision. One-year survival and major residual leak were used as the criteria for the analysis of survival and technical success, respectively. In protocol 1, clinical variables were evaluated as predictors of one-year mortality. In protocol 2, surgical techniques were evaluated as predictors of major residual leak, which was found to be related to one-year mortality in protocol 1. RESULTS In protocol 1, the one-year mortality was higher in patients with major residual leak (75 %, 3/4) than in those without (15 %, 3/20) (p = 0.035). In protocol 2, the patients with major residual leak had smaller patches than those without (41.9 ± 3.8 vs. 47.8 ± 4.8 mm, p = 0.031) and a smaller size difference between the patches and the VSD (22.5 ± 6.5 vs. 30.0 ± 5.7 mm, p = 0.028). CONCLUSION For the "sandwich technique" via a right ventricular approach to treat post-infarction VSD, the choice of patch size according to VSD size is an important variable for reducing major residual leak.
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Affiliation(s)
- Susumu Isoda
- Department of Cardiovascular Surgery, Fujisawa Municipal Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan.
| | - Kiyotaka Imoto
- Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan
| | - Keiji Uchida
- Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan
| | - Norihisa Karube
- Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan
| | - Keiichiro Kasama
- Department of Cardiovascular Surgery, Yokohama City University Medical Center, 4-57 Urafune, Minami, Yokohama, 232-0024, Japan
| | - Ichiya Yamazaki
- Department of Cardiovascular Surgery, Fujisawa Municipal Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan
| | - Shinichi Suzuki
- Department of Surgery, Yokohama City University, 3-9 Fukuura Kanazawa, Yokohama, 236-0004, Japan
| | - Yoshimi Yano
- Yano Heart Clinic1099-5 Fujisawa, Fujisawa, 251-0052, Japan
| | - Yusuke Matsuki
- Department of Cardiovascular Surgery, Fujisawa Municipal Hospital, 2-6-1 Fujisawa, Fujisawa, 251-0052, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9 Fukuura Kanazawa, Yokohama, 236-0004, Japan
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Aniulis E, Churches O, Thomas NA, Nicholls MER. Representational pseudoneglect for detecting changes to Rey-Osterrieth figures. Exp Brain Res 2016; 234:3381-3387. [PMID: 27461110 DOI: 10.1007/s00221-016-4735-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
When dividing attention between the left and right sides of physical space, most individuals pay slightly more attention to the left side. This phenomenon, known as pseudoneglect, may also occur for the left and right sides of mental representations of stimuli. Representational pseudoneglect has been shown for the recall of real-world scenes and for simple, briefly presented stimuli. The current study sought to investigate the effect of exposure duration and complexity using adaptations of the Rey-Osterrieth figures. Undergraduates (n = 97) were shown a stimulus for 20 s and asked to remember it. Participants were then shown a probe and indicated whether it was the same or different. Results showed that, irrespective of whether an element was added or subtracted, changes on the left side of the remembered image were better detected. These results are consistent with representational pseudoneglect and demonstrate that this effect occurs for complex stimuli when presented for an extended period of time. Representation neglect is therefore unlikely to be the result of an initial saccade to the left-but could be related to the formation or recall of the representation.
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Affiliation(s)
- Ellie Aniulis
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Owen Churches
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Nicole A Thomas
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael E R Nicholls
- School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Watts RP, Bilska I, Diab S, Dunster KR, Bulmer AC, Barnett AG, Fraser JF. Novel 24-h ovine model of brain death to study the profile of the endothelin axis during cardiopulmonary injury. Intensive Care Med Exp 2015; 3:31. [PMID: 26596583 PMCID: PMC4656265 DOI: 10.1186/s40635-015-0067-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 11/13/2015] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Upregulation of the endothelin axis has been observed in pulmonary tissue after brain death, contributing to primary graft dysfunction and ischaemia reperfusion injury. The current study aimed to develop a novel, 24-h, clinically relevant, ovine model of brain death to investigate the profile of the endothelin axis during brain death-associated cardiopulmonary injury. We hypothesised that brain death in sheep would also result in demonstrable injury to other transplantable organs. METHODS Twelve merino cross ewes were randomised into two groups. Following induction of general anaesthesia and placement of invasive monitoring, brain death was induced in six animals by inflation of an extradural catheter. All animals were supported in an intensive care unit environment for 24 h. Animal management reflected current human donor management, including administration of vasopressors, inotropes and hormone resuscitation therapy. Activation of the endothelin axis and transplantable organ injury were assessed using ELISA, immunohistochemistry and standard biochemical markers. RESULTS All animals were successfully supported for 24 h. ELISA suggested early endothelin-1 and big endothelin-1 release, peaking 1 and 6 h after BD, respectively, but there was no difference at 24 h. Immunohistochemistry confirmed the presence of the endothelin axis in pulmonary tissue. Brain dead animals demonstrated tachycardia and hypertension, followed by haemodynamic collapse, typified by a reduction in systemic vascular resistance to 46 ± 1 % of baseline. Mean pulmonary artery pressure rose to 186 ± 20 % of baseline at induction and remained elevated throughout the protocol, reaching 25 ± 2.2 mmHg at 24 h. Right ventricular stroke work increased 25.9 % above baseline by 24 h. Systemic markers of cardiac and hepatocellular injury were significantly elevated, with no evidence of renal dysfunction. CONCLUSIONS This novel, clinically relevant, ovine model of brain death demonstrated that increased pulmonary artery pressures are observed after brain death. This may contribute to right ventricular dysfunction and pulmonary injury. The development of this model will allow for further investigation of therapeutic strategies to minimise the deleterious effects of brain death on potentially transplantable organs.
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Affiliation(s)
- Ryan P Watts
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia.
- University of Queensland, Brisbane, Queensland, Australia.
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
| | - Izabela Bilska
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia.
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Southport, Queensland, Australia.
| | - Sara Diab
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia.
| | - Kimble R Dunster
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia.
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Andrew C Bulmer
- Heart Foundation Research Centre, Griffith Health Institute, Griffith University, Southport, Queensland, Australia.
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Queensland, Australia.
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
- University of Queensland, Brisbane, Queensland, Australia.
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23
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Shen H, Yang J, Huang Q, Jiang MJ, Tan YN, Fu JF, Zhu LZ, Fang XF, Yuan Y. Different treatment strategies and molecular features between right-sided and left-sided colon cancers. World J Gastroenterol 2015; 21:6470-6478. [PMID: 26074686 PMCID: PMC4458758 DOI: 10.3748/wjg.v21.i21.6470] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/24/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
The colon is derived from the embryological midgut and hindgut separately, with the right colon and left colon having different features with regards to both anatomical and physiological characteristics. Cancers located in the right and left colon are referred to as right colon cancer (RCC) and left colon cancer (LCC), respectively, based on their apparent anatomical positions. Increasing evidence supports the notion that not only are there differences in treatment strategies when dealing with RCC and LCC, but molecular features also vary between them, not to mention the distinguishing clinical manifestations. Disease-free survival after radical surgery of both RCC and LCC are similar. In the treatment of RCC, the benefit gained from adjuvant FOLFIRI chemotherapy is superior, or at least similar, to LCC, but inferior to LCC if FOLFOX regimen is applied. On the other hand, metastatic LCC exhibits longer survival than that of RCC in a palliative chemotherapy setting. For KRAS wild-type cancers, LCC benefits more from cetuximab treatment than RCC. Moreover, advanced LCC shows a higher sensitivity to bevacizumab treatment in comparison with advanced RCC. Significant varieties exist at the molecular level between RCC and LCC, which may serve as the cause of all apparent differences. With respect to carcinogenesis mechanisms, RCC is associated with known gene types, such as MMR, KRAS, BRAF, and miRNA-31, while LCC is associated with CIN, p53, NRAS, miRNA-146a, miRNA-147b, and miRNA-1288. Regarding protein expression, RCC is related to GNAS, NQO1, telomerase activity, P-PDH, and annexin A10, while LCC is related to Topo I, TS, and EGFR. In addition, separated pathways dominate progression to relapse in RCC and LCC. Therefore, RCC and LCC should be regarded as two heterogeneous entities, with this heterogeneity being used to stratify patients in order for them to have the optimal, current, and novel therapeutic strategies in clinical practice. Additional research is needed to uncover further differences between RCC and LCC.
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Jolobe OMP. Right ventricular mural thrombus formation superimposed on previous anterior myocardial infarction. Int J Cardiol 2015; 186:125. [PMID: 25814358 DOI: 10.1016/j.ijcard.2015.03.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Oscar M P Jolobe
- MRCP(UK), Manchester Medical Society, Simon Building, Brunswick Street, Manchester M13 9PL, United Kingdom.
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Lee M, Suh MK, Lee MH, Lee JS, Moon SY. Agraphia caused by acute right parietal infarction. J Clin Neurosci 2015; 22:758-60. [PMID: 25564267 DOI: 10.1016/j.jocn.2014.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 11/30/2022]
Abstract
Injury in the dominant language hemisphere typically leads to agraphia, however we report a patient with agraphia after injury to the right angular gyrus. A 71-year-old Korean woman presented with the complaint of an inability to write for the last 7 days. The patient had been illiterate for most of her life, but had started learning to write Hangul, the Korean alphabet, at a welfare center 3 years ago. On language screening she was unable to write although she could read, and other language functions showed no abnormalities. Brain MRI showed acute infarction in the right angular gyrus. Her writing patterns displayed features of surface agraphia, indicative of phoneme-to-grapheme conversion with phonetic writing of targets. Additionally, she manifested visual errors. A functional MRI indicated that her left hemisphere was language dominant. This patient experienced agraphia resulting from pure impairment of visuo-constructive function after acute infarction in the right angular gyrus.
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Affiliation(s)
- Manyong Lee
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea
| | - Mee Kyung Suh
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Myung Hyun Lee
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea
| | - So Young Moon
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea.
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Forsha D, Risum N, Kropf PA, Rajagopal S, Smith PB, Kanter RJ, Samad Z, Sogaard P, Barker P, Kisslo J. Right ventricular mechanics using a novel comprehensive three-view echocardiographic strain analysis in a normal population. J Am Soc Echocardiogr 2014; 27:413-22. [PMID: 24508364 PMCID: PMC4052609 DOI: 10.1016/j.echo.2013.12.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although quantitative right ventricular (RV) strain analysis may be useful in congenital and acquired heart disease populations with RV failure, a comprehensive, standardized approach is lacking. An 18-segment RV strain analysis obtained from three standardized RV apical echocardiographic images was used to determine the feasibility, normal values, and reproducibility of the method in normal adults. METHODS Forty healthy, prospectively enrolled volunteers with no cardiac histories and normal QRS durations underwent echocardiography optimized for strain analysis including three RV apical views. Two-dimensional speckle-tracking longitudinal strain analysis was performed using EchoPAC software. Eleven retrospectively identified subjects with RV disease were included as a pilot population. All had been imaged using the same protocol including the three RV apical views. RESULTS All control subjects had normal anatomic morphology and function by echocardiography. Feasibility of the RV strain analysis was good (adequate tracking in 696 of 720 segments [97%]). RV global peak systolic strain was -23 ± 2%. Peak strain was highest in the RV free wall and lowest in the septum. Dyssynchrony indices demonstrated no dyssynchrony using left ventricular criteria. Reproducibility of most strain measures was acceptable. This methodology identified important disease not seen in the four-chamber apical view alone in the pilot population of 11 patients with RV disease. Strain patterns and values were different from those in the control population, indicating that differences do exist from normal. CONCLUSIONS Eighteen-segment RV strain analysis is feasible, with strain measures falling into discrete ranges in this normal population. Those with RV disease illustrate the potential utility of this approach. These data indicate that this model can be used for more detailed studies evaluating abnormal RV populations, in which its full potential can be assessed.
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Affiliation(s)
- Daniel Forsha
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina.
| | - Niels Risum
- Department of Cardiology, Gentofte University Hospital, Gentofte, Denmark
| | - P Andrea Kropf
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Sudarshan Rajagopal
- Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - P Brian Smith
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ronald J Kanter
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Zainab Samad
- Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Peter Sogaard
- Department of Cardiology, Aalborg University, Aalborg, Denmark
| | - Piers Barker
- Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Joseph Kisslo
- Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
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Pankert M, Cuisset T, Aldebert P, Cavaille G, Quilici J, Lambert M, Bonnet JL. Unusual cause of hypoxemia in myocardial infarction: interventional management. Int J Cardiol 2014; 172:e436-7. [PMID: 24438933 DOI: 10.1016/j.ijcard.2013.12.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Mathieu Pankert
- Département de Cardiologie, CHU Timone, Marseille F-13385, France; Aix-Marseille Univ, INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, F-13385 Marseille, France.
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille F-13385, France; Aix-Marseille Univ, INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, F-13385 Marseille, France
| | - Philippe Aldebert
- Département de Cardiologie, CHU Timone, Marseille F-13385, France; Service de cardio-pédiatrie, CHU Timone, Marseille F-13385, France
| | - Guilhem Cavaille
- Département de Cardiologie, CHU Timone, Marseille F-13385, France
| | - Jacques Quilici
- Département de Cardiologie, CHU Timone, Marseille F-13385, France; Aix-Marseille Univ, INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, F-13385 Marseille, France
| | - Marc Lambert
- Département de Cardiologie, CHU Timone, Marseille F-13385, France; Aix-Marseille Univ, INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, F-13385 Marseille, France
| | - Jean-Louis Bonnet
- Département de Cardiologie, CHU Timone, Marseille F-13385, France; Aix-Marseille Univ, INSERM UMR1062, INRA UMR1260, Nutrition, Obesity and Risk of Thrombosis, Faculty of Medicine, F-13385 Marseille, France
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Okeibunor JC, Akanmori BD, Balcha GM, Mihigo R, Vaz RM, Nshimirimana D. Enhancing access to immunization services and exploiting the benefits of recent innovations in the African region. Vaccine 2013; 31:3772-6. [PMID: 23800541 DOI: 10.1016/j.vaccine.2013.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/11/2013] [Accepted: 06/11/2013] [Indexed: 11/28/2022]
Abstract
The African Regional Office of the World Health Organization (WHO AFRO) organized the annual regional conference on immunization (ARCI) from 10 to 12 December 2012 in Dar es Salaam, Tanzania, under the theme, "Innovations, access and the right of all to vaccines". The meeting reviewed the status of immunization in the region and identified all innovations, strategies and technologies available and how these could be fully utilized to enhance the access and the rights of all to vaccines. Over 50 oral presentations were made in plenary and parallel sessions of the conference which was attended by over 200 participants drawn from national immunization programs, academia, public health experts and immunization partners. In addition there were 40 poster presentations. This manuscript summarizes of the meeting, highlighting the innovations in immunization being piloted or scaled-up, their impact and suggesting ways to further improve immunization service delivery for the eradication, elimination and control of vaccine-preventable diseases in the region.
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Affiliation(s)
- J C Okeibunor
- Immunization and Vaccines Development Cluster, WHO Regional Office for Africa, Box 06 Djoue, Brazzaville, Congo.
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