Pub Date : 2022-07-01DOI: 10.1080/08941939.2022.2062496
Hakan Anıl, Nevzat Can Şener, Kaan Karamık, İbrahim Erol, Ediz Vuruşkan, Hakan Erçil, Zafer Gökhan Gürbüz
Purpose: Comparing the two different drainage methods of percutaneous nephrostomy (PCN) versus retrograde ureteral double - J (DJ) stent insertion in patients with obstructive pyelonephritis cases.
Material and methods: In this retrospective study, patients with obstructive pyelonephritis secondary to urolithiasis who underwent PCN or DJ insertion were included in the study. Patients were divided into two groups according to drainage method. After exclusion criteria, the study included 105 patients. The groups were compared for intraoperative outcomes, duration of fluoroscopy usage, the time needed for normalization of infection parameters (white blood cells (WBC), C - reactive protein (CRP), procalcitonin), and complications were observed.
Results: From 105 patients, 56 patients were in DJ stent group and 49 patients were in PCN group. According to intraoperative data, operative time and fluoroscopy duration were significantly shorter in the DJ ureteral stent group (P < .001). WBC returned to normal range in mean 3.5 ± 1.3 days in the DJ stent group and 3.2 ± 1.1 days in the PCN group (95% CI: -0.76-0.21, P = .268). There were no statistically significant differences identified for the duration for CRP, PCT and fever to return to normal range between the drainage methods. The complication rates was 51.8% for DJ stent group and, 30.6% in PCN group (P = .028).
Conclusion: Both methods are effective and safe in obstructive pyelonephritis. Despite the higher complication rate in DJ stent group, these complications were minor.
{"title":"Comparison of Percutaneous Nephrostomy and Ureteral DJ Stent in Patients with Obstructive Pyelonephritis: A Retrospective Cohort Study.","authors":"Hakan Anıl, Nevzat Can Şener, Kaan Karamık, İbrahim Erol, Ediz Vuruşkan, Hakan Erçil, Zafer Gökhan Gürbüz","doi":"10.1080/08941939.2022.2062496","DOIUrl":"https://doi.org/10.1080/08941939.2022.2062496","url":null,"abstract":"<p><strong>Purpose: </strong>Comparing the two different drainage methods of percutaneous nephrostomy (PCN) versus retrograde ureteral double - J (DJ) stent insertion in patients with obstructive pyelonephritis cases.</p><p><strong>Material and methods: </strong>In this retrospective study, patients with obstructive pyelonephritis secondary to urolithiasis who underwent PCN or DJ insertion were included in the study. Patients were divided into two groups according to drainage method. After exclusion criteria, the study included 105 patients. The groups were compared for intraoperative outcomes, duration of fluoroscopy usage, the time needed for normalization of infection parameters (white blood cells (WBC), C - reactive protein (CRP), procalcitonin), and complications were observed.</p><p><strong>Results: </strong>From 105 patients, 56 patients were in DJ stent group and 49 patients were in PCN group. According to intraoperative data, operative time and fluoroscopy duration were significantly shorter in the DJ ureteral stent group (<i>P</i> < .001). WBC returned to normal range in mean 3.5 ± 1.3 days in the DJ stent group and 3.2 ± 1.1 days in the PCN group (95% CI: -0.76-0.21, <i>P</i> = .268). There were no statistically significant differences identified for the duration for CRP, PCT and fever to return to normal range between the drainage methods. The complication rates was 51.8% for DJ stent group and, 30.6% in PCN group (<i>P</i> = .028).</p><p><strong>Conclusion: </strong>Both methods are effective and safe in obstructive pyelonephritis. Despite the higher complication rate in DJ stent group, these complications were minor.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 7","pages":"1445-1450"},"PeriodicalIF":1.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10439942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-01Epub Date: 2022-04-17DOI: 10.1080/08941939.2022.2064010
Onat Akyol, Serdar Demirgan, Aslıhan Şengelen, Hasan Cem Güneyli, Duygu Sultan Oran, Funda Yıldırım, Damla Haktanır, Mehmet Salih Sevdi, Kerem Erkalp, Ayşin Selcan
Objectives: Targeted temperature management (TTM) with therapeutic hypothermia (TH) has an organ-protective effect by mainly reducing inflammatory response. Here, our objective was to determine, for the first time, whether mild TH with external cooling, a simple and inexpensive method, could be safe or even beneficial in two-hit rabbit model of acute lung injury/acute respiratory distress syndrome (ALI/ARDS).
Methods: Twenty-two New Zealand rabbits (6-month-old) were randomly divided into healthy control (HC) with conventional ventilation, but without injury, model group (ALI), and hypothermia group with external cooling (ALI-HT). After induction of ALI/ARDS through mild lung-lavages followed by non-protective ventilation, mild hypothermia was started in ALI-HT group (body temperature of 33-34 °C). All rabbits were conventionally ventilated for an additional 6-h by recording respiratory parameters. Finally, lung histopathology and inflammatory response were evaluated.
Results: Hypothermia was associated with higher oxygen saturation, resulting in partial improvement in the P/F ratio (PaO2/FiO2), oxygenation index, mean airway pressure, and PaCO2, but did not affect lactate levels. The ALI-HT group had lower histopathological injury scores (hyperemia, edema, emphysema, atelectasis, and PMN infiltration). Further, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6 and -8 levels in lung tissue and serum samples markedly reduced due to hypothermia.
Conclusion: Mild TH with external cooling reduced lung inflammation and damage, whereas it resulted in partial improvement in gas exchanges. Our findings highlight that body temperature control may be a potentially supportive therapeutic option for regulating cytokine production and respiratory parameters in ALI/ARDS.
{"title":"Mild Hypothermia via External Cooling Improves Lung Function and Alleviates Pulmonary Inflammatory Response and Damage in Two-Hit Rabbit Model of Acute Lung Injury.","authors":"Onat Akyol, Serdar Demirgan, Aslıhan Şengelen, Hasan Cem Güneyli, Duygu Sultan Oran, Funda Yıldırım, Damla Haktanır, Mehmet Salih Sevdi, Kerem Erkalp, Ayşin Selcan","doi":"10.1080/08941939.2022.2064010","DOIUrl":"https://doi.org/10.1080/08941939.2022.2064010","url":null,"abstract":"<p><strong>Objectives: </strong>Targeted temperature management (TTM) with therapeutic hypothermia (TH) has an organ-protective effect by mainly reducing inflammatory response. Here, our objective was to determine, for the first time, whether mild TH with external cooling, a simple and inexpensive method, could be safe or even beneficial in two-hit rabbit model of acute lung injury/acute respiratory distress syndrome (ALI/ARDS).</p><p><strong>Methods: </strong>Twenty-two New Zealand rabbits (6-month-old) were randomly divided into healthy control (HC) with conventional ventilation, but without injury, model group (ALI), and hypothermia group with external cooling (ALI-HT). After induction of ALI/ARDS through mild lung-lavages followed by non-protective ventilation, mild hypothermia was started in ALI-HT group (body temperature of 33-34 °C). All rabbits were conventionally ventilated for an additional 6-h by recording respiratory parameters. Finally, lung histopathology and inflammatory response were evaluated.</p><p><strong>Results: </strong>Hypothermia was associated with higher oxygen saturation, resulting in partial improvement in the P/F ratio (PaO<sub>2</sub>/FiO<sub>2</sub>), oxygenation index, mean airway pressure, and PaCO<sub>2</sub>, but did not affect lactate levels. The ALI-HT group had lower histopathological injury scores (hyperemia, edema, emphysema, atelectasis, and PMN infiltration). Further, tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6 and -8 levels in lung tissue and serum samples markedly reduced due to hypothermia.</p><p><strong>Conclusion: </strong>Mild TH with external cooling reduced lung inflammation and damage, whereas it resulted in partial improvement in gas exchanges. Our findings highlight that body temperature control may be a potentially supportive therapeutic option for regulating cytokine production and respiratory parameters in ALI/ARDS.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 7","pages":"1472-1483"},"PeriodicalIF":1.9,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41114981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-12DOI: 10.1080/08941939.2022.2084188
A. Farouk, R. Hamed, S. Elsawy, Nashwa F Abd El Hafez, F. Moftah, M. Nassar, Fify Alfy Gabra, T. Saleem
Abstract Background: Cardiac surgeries induce many inflammatory responses with remarkable clinical implications. Tryptophan (Trp) is a precursor for serotonin, melatonin and kynurenine (Kyn). Plasma kynurenic acid (Kyna) and Kyn concentrations are thought to be related to the severity of inflammation. Plasma Trp/Kyn ratio is used to measure inflammatory cytokine activity. Methods: We performed the current longitudinal study in a tertiary care center and included 62 patients divided into two groups; group A (on-pump CABG patients) and group B (off-pump CABG patients). Plasma Trp and Kyn were measured using the high-performance liquid chromatography (HPLC) technique. Serum interlukin-6 (IL-6) and white blood cells (WBCs) were measured using ELISA and routine blood count, respectively. Results: The present study revealed that the intraoperative levels of plasma Kyn, IL-6 and WBCs were significantly increased while the plasma Trp/Kyn ratio was significantly decreased in both the groups; however, the changes were more significant in the on-pump CABG group. Moreover, the levels in both the groups returned to preoperative levels 72 h postoperative. Our study has shown that WBCs is positively correlated with IL-6, but has negative correlation with Trp/Kyn ratio. Conclusions: Kyn and Trp/Kyn ratio might be utilized as markers of the severity of inflammation in major surgery. In addition, off-pump CABG might be more preferable than on-pump CABG regarding stress and release of inflammatory markers.
{"title":"Measuring the Systemic Inflammatory Response to On- and Off-Pump Coronary Artery Bypass Graft (CABG) Surgeries Using the Tryptophan/Kynurenine Pathway","authors":"A. Farouk, R. Hamed, S. Elsawy, Nashwa F Abd El Hafez, F. Moftah, M. Nassar, Fify Alfy Gabra, T. Saleem","doi":"10.1080/08941939.2022.2084188","DOIUrl":"https://doi.org/10.1080/08941939.2022.2084188","url":null,"abstract":"Abstract Background: Cardiac surgeries induce many inflammatory responses with remarkable clinical implications. Tryptophan (Trp) is a precursor for serotonin, melatonin and kynurenine (Kyn). Plasma kynurenic acid (Kyna) and Kyn concentrations are thought to be related to the severity of inflammation. Plasma Trp/Kyn ratio is used to measure inflammatory cytokine activity. Methods: We performed the current longitudinal study in a tertiary care center and included 62 patients divided into two groups; group A (on-pump CABG patients) and group B (off-pump CABG patients). Plasma Trp and Kyn were measured using the high-performance liquid chromatography (HPLC) technique. Serum interlukin-6 (IL-6) and white blood cells (WBCs) were measured using ELISA and routine blood count, respectively. Results: The present study revealed that the intraoperative levels of plasma Kyn, IL-6 and WBCs were significantly increased while the plasma Trp/Kyn ratio was significantly decreased in both the groups; however, the changes were more significant in the on-pump CABG group. Moreover, the levels in both the groups returned to preoperative levels 72 h postoperative. Our study has shown that WBCs is positively correlated with IL-6, but has negative correlation with Trp/Kyn ratio. Conclusions: Kyn and Trp/Kyn ratio might be utilized as markers of the severity of inflammation in major surgery. In addition, off-pump CABG might be more preferable than on-pump CABG regarding stress and release of inflammatory markers.","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 1","pages":"1621 - 1625"},"PeriodicalIF":1.9,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42739965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-12DOI: 10.1080/08941939.2022.2084190
C. Iavazzo, I. Gkegkes
Dear Editor, With great deal of interest, we read the article entitled “The effect of mechanical bowel preparation on the surgical field in laparoscopic gynecologic surgeries: A prospective randomized controlled trial” by Ozturk et al. [1] The study evaluates the effects of mechanical bowel preparation (MBP) prior to laparoscopic gynecologic operation and whether it can offer advantages intraoperatively. As already discussed, MBP is discouraged in such operations by ERAS guidelines [2]. It should be highlighted that MBP was applied for two days prior to surgery. A fact that could raise the cost and patient’s dissatisfaction. Moreover, the evaluation of the intraoperative visualization of the surgical field, intestinal load and overall case of surgery were based on the subjective opinion of an experienced laparoscopic surgeon, and this is similar to other studies, using for example the Likert scale [3]. A recent literature review showed that MBP of any type seems to offer no advantage to any of the above mentioned intraoperative parametres [4]. Another metanalysis proposed that MBP should be abandoned prior to benign laparoscopic gynecological operations [5]. Furthermore, in the subgroup analysis of your study, no significant differences were identified in either patients with malignant diseases or those with high body mass index. Such a finding is crucial and highlights that there is no role of MBP in gynecologic laparoscopy independent of the difficulty of the planned surgery. Although, the findings of your study as well as other studies on the field are not supportive for MBP use, we should also mention that there is a gap between guidelines and reality/current medical practise as the approach is based on surgeon’s preference worldwide [6]. Nevertheless, the role of MBP could be debated by some surgeons in their contemporary practise, based on the existing data, we recommend that MBP could be abandoned in the modern era of minimally invasive gynecologic surgery and enhanced recovery pathways. Once again, we would like to thank the authors for their excellent contribution. Data availability statement
{"title":"Mechanical Bowel Preparation Can Be Omitted in the Modern Era of Minimally Invasive Gynaecological Surgery and ERAS Pathways","authors":"C. Iavazzo, I. Gkegkes","doi":"10.1080/08941939.2022.2084190","DOIUrl":"https://doi.org/10.1080/08941939.2022.2084190","url":null,"abstract":"Dear Editor, With great deal of interest, we read the article entitled “The effect of mechanical bowel preparation on the surgical field in laparoscopic gynecologic surgeries: A prospective randomized controlled trial” by Ozturk et al. [1] The study evaluates the effects of mechanical bowel preparation (MBP) prior to laparoscopic gynecologic operation and whether it can offer advantages intraoperatively. As already discussed, MBP is discouraged in such operations by ERAS guidelines [2]. It should be highlighted that MBP was applied for two days prior to surgery. A fact that could raise the cost and patient’s dissatisfaction. Moreover, the evaluation of the intraoperative visualization of the surgical field, intestinal load and overall case of surgery were based on the subjective opinion of an experienced laparoscopic surgeon, and this is similar to other studies, using for example the Likert scale [3]. A recent literature review showed that MBP of any type seems to offer no advantage to any of the above mentioned intraoperative parametres [4]. Another metanalysis proposed that MBP should be abandoned prior to benign laparoscopic gynecological operations [5]. Furthermore, in the subgroup analysis of your study, no significant differences were identified in either patients with malignant diseases or those with high body mass index. Such a finding is crucial and highlights that there is no role of MBP in gynecologic laparoscopy independent of the difficulty of the planned surgery. Although, the findings of your study as well as other studies on the field are not supportive for MBP use, we should also mention that there is a gap between guidelines and reality/current medical practise as the approach is based on surgeon’s preference worldwide [6]. Nevertheless, the role of MBP could be debated by some surgeons in their contemporary practise, based on the existing data, we recommend that MBP could be abandoned in the modern era of minimally invasive gynecologic surgery and enhanced recovery pathways. Once again, we would like to thank the authors for their excellent contribution. Data availability statement","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 1","pages":"1609 - 1609"},"PeriodicalIF":1.9,"publicationDate":"2022-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42326183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2021-12-29DOI: 10.1080/08941939.2021.2021333
Rafael Rodrigues Torres, Ana Cristina Aoun Tannuri, Suellen Serafini, Alessandro Belon, Josiane Oliveira Gonçalves, Celso di Loreto, Uenis Tannuri
Background: In pediatric liver transplantation, the optimal size of the transplanted liver ranges between 0.8% and 4.0% of the recipient's weight. Sometimes, the graft weight exceeds this upper limit, characterizing the large-for-size condition potentially associated with reduced blood flow and worsening of ischemia-reperfusion injury. Therefore, it would be beneficial to increase the portal flow through arterialization of the portal vein. Materials and methods: Fifteen pigs underwent large-for-size liver transplants. They were divided into two groups: control (CTRL 6 animals - conventional technique) and arterialization - a shunt was established between the portal vein and the splenic artery (ART 9 animals). Hemodynamic, biochemical, histological, and molecular variables were compared. Results: Arterialization resulted in a significant increase in portal vein pressure but no changes in other hemodynamic variables, as shown in the analysis of variance. It was observed lower ALT values (p = 0.007), with no differences regarding the values of blood pH and lactate (p = 0.54 and p = 0.699 respectively) or histological variables (edema, steatosis, inflammation, necrosis, and IRI - p = 1.0, p = 0.943, p = 0.174, p = 0.832, p = 0.662, respectively). The molecular studies showed significantly increased expression of IL6 after 3 hours of reperfusion (p = 0.048) and decreased expression of ICAM immediately after reperfusion (p = 0.03). The regression analysis suggested a positive influence of portal flow and pressure on biochemical parameters. Conclusion: Arterialization of the portal vein showed no histological, biochemical, or molecular benefits in large-for-size transplantation.
{"title":"Does Arterialization of Portal Vein Have Any Effects in Large-for-Size Liver Transplantation? Hemodynamic, Histological, and Biomolecular Experimental Studies.","authors":"Rafael Rodrigues Torres, Ana Cristina Aoun Tannuri, Suellen Serafini, Alessandro Belon, Josiane Oliveira Gonçalves, Celso di Loreto, Uenis Tannuri","doi":"10.1080/08941939.2021.2021333","DOIUrl":"https://doi.org/10.1080/08941939.2021.2021333","url":null,"abstract":"<p><strong>Background: </strong>In pediatric liver transplantation, the optimal size of the transplanted liver ranges between 0.8% and 4.0% of the recipient's weight. Sometimes, the graft weight exceeds this upper limit, characterizing the large-for-size condition potentially associated with reduced blood flow and worsening of ischemia-reperfusion injury. Therefore, it would be beneficial to increase the portal flow through arterialization of the portal vein. <b>Materials and methods:</b> Fifteen pigs underwent large-for-size liver transplants. They were divided into two groups: control (CTRL 6 animals - conventional technique) and arterialization - a shunt was established between the portal vein and the splenic artery (ART 9 animals). Hemodynamic, biochemical, histological, and molecular variables were compared. <b>Results</b>: Arterialization resulted in a significant increase in portal vein pressure but no changes in other hemodynamic variables, as shown in the analysis of variance. It was observed lower ALT values (<i>p</i> = 0.007), with no differences regarding the values of blood pH and lactate (<i>p</i> = 0.54 and <i>p</i> = 0.699 respectively) or histological variables (edema, steatosis, inflammation, necrosis, and IRI - <i>p</i> = 1.0, <i>p</i> = 0.943, <i>p</i> = 0.174, <i>p</i> = 0.832, <i>p</i> = 0.662, respectively). The molecular studies showed significantly increased expression of IL6 after 3 hours of reperfusion (<i>p</i> = 0.048) and decreased expression of ICAM immediately after reperfusion (<i>p</i> = 0.03). The regression analysis suggested a positive influence of portal flow and pressure on biochemical parameters. <b>Conclusion</b>: Arterialization of the portal vein showed no histological, biochemical, or molecular benefits in large-for-size transplantation.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 6","pages":"1197-1207"},"PeriodicalIF":1.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39648129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2022-02-10DOI: 10.1080/08941939.2022.2035858
Xinggang Guo, Wenli Zhang, Jin Du, Rongsuo Tao, Wei Dong, Jian Huang, Jinmin Zhang, Zeya Pan, Weiping Zhou, Xiuli Zhu, Hui Liu, Fuchen Liu
Objective: To elucidate the impact of acute-phase protein serum amyloid A (aSAA) on microvascular invasion (MVI) and early recurrence in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).
Methods: HBV-related HCC patients (n = 192) undergoing liver resection were included in the study. The protein levels of aSAA were analyzed by immunohistochemical staining in 172 tumor specimens, and further detected via western blotting in HCC and their corresponding portal vein tumor thrombus (PVTT) (n = 20). Cox and logit regression analysis was performed. Exploratory subgroup analysis was used to balance the potential confounders.
Results: HBV-related HCC patients with high aSAA levels tended to have high HBV-DNA loads. Logit and Cox regression analyses revealed high expression of aSAA is an independent risk factor not only for MVI (OR 5.384, 95% CI 2.286-13.301, P < 0.001) but also for early recurrence (HR 6.040, 95% CI 1.970-18.540, P = 0.002), overall recurrence (HR 3.720, 95% CI 2.140-6.450, P < 0.001), and overall survival (HR 4.15, 95% CI 2.380-7.230, P < 0.001). Subgroup analysis showed that the effects of aSAA were consistent across all subgroups examined. Additionally, the aSAA protein level was significantly higher in PVTT than that in its corresponding tumor specimen. A high HBV-DNA level and large tumor size were the independent risk factors for early HCC recurrence in patients with high levels of aSAA.
Conclusions: High expression of aSAA was an independent risk factor for MVI and early tumor recurrence in HBV-related HCC patients after liver resection. The aSAA protein level could thus be a promising biomarker for predicting MVI and early recurrence in these patients.
目的:探讨急性期蛋白血清淀粉样蛋白A (aSAA)对乙型肝炎病毒(HBV)相关性肝细胞癌(HCC)微血管侵袭(MVI)和早期复发的影响。方法:纳入192例行肝切除术的hbv相关HCC患者。应用免疫组化染色分析172例肿瘤标本中aSAA蛋白水平,并应用western blotting检测肝癌及其相应门静脉肿瘤血栓(PVTT) (n = 20)中aSAA蛋白水平。进行Cox和logit回归分析。探索性亚组分析用于平衡潜在的混杂因素。结果:高aSAA水平的hbv相关HCC患者往往具有高HBV-DNA负荷。Logit和Cox回归分析显示,aSAA高表达不仅是MVI的独立危险因素(OR 5.384, 95% CI 2.286 ~ 13.301, P P = 0.002),而且是总复发的独立危险因素(HR 3.720, 95% CI 2.140 ~ 6.450, P P)。结论:aSAA高表达是hbv相关HCC患者肝切除术后MVI和早期肿瘤复发的独立危险因素。因此,aSAA蛋白水平可能是预测这些患者MVI和早期复发的有希望的生物标志物。
{"title":"Acute-Phase Serum Amyloid A May Predict Microvascular Invasion and Early Tumor Recurrence in Patients with Hepatitis B Virus-Related Hepatocellular Carcinoma Undergoing Liver Resection.","authors":"Xinggang Guo, Wenli Zhang, Jin Du, Rongsuo Tao, Wei Dong, Jian Huang, Jinmin Zhang, Zeya Pan, Weiping Zhou, Xiuli Zhu, Hui Liu, Fuchen Liu","doi":"10.1080/08941939.2022.2035858","DOIUrl":"https://doi.org/10.1080/08941939.2022.2035858","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate the impact of acute-phase protein serum amyloid A (aSAA) on microvascular invasion (MVI) and early recurrence in hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).</p><p><strong>Methods: </strong>HBV-related HCC patients (<i>n</i> = 192) undergoing liver resection were included in the study. The protein levels of aSAA were analyzed by immunohistochemical staining in 172 tumor specimens, and further detected via western blotting in HCC and their corresponding portal vein tumor thrombus (PVTT) (<i>n</i> = 20). Cox and logit regression analysis was performed. Exploratory subgroup analysis was used to balance the potential confounders.</p><p><strong>Results: </strong>HBV-related HCC patients with high aSAA levels tended to have high HBV-DNA loads. Logit and Cox regression analyses revealed high expression of aSAA is an independent risk factor not only for MVI (OR 5.384, 95% CI 2.286-13.301, <i>P</i> < 0.001) but also for early recurrence (HR 6.040, 95% CI 1.970-18.540, <i>P</i> = 0.002), overall recurrence (HR 3.720, 95% CI 2.140-6.450, <i>P</i> < 0.001), and overall survival (HR 4.15, 95% CI 2.380-7.230, <i>P</i> < 0.001). Subgroup analysis showed that the effects of aSAA were consistent across all subgroups examined. Additionally, the aSAA protein level was significantly higher in PVTT than that in its corresponding tumor specimen. A high HBV-DNA level and large tumor size were the independent risk factors for early HCC recurrence in patients with high levels of aSAA.</p><p><strong>Conclusions: </strong>High expression of aSAA was an independent risk factor for MVI and early tumor recurrence in HBV-related HCC patients after liver resection. The aSAA protein level could thus be a promising biomarker for predicting MVI and early recurrence in these patients.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 6","pages":"1368-1376"},"PeriodicalIF":1.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39782988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Short bowel syndrome (SBS) remains an unsolved issue in modern medicine. Numerous experimental surgical techniques have been proposed in the attempt to increase the intestinal absorptive capacity.Materials and Methods: Ten female Landrace pigs, divided in two groups of 5 (A and B), were explored through a midline incision. A spindle-shaped vascularized full-thickness gastric wall flap (GWF) consisting of part of the major curvature with the gastroepiploic arch preserved was de-epithelialized and then placed as a "patch" to cover an antimesenteric border defect of either a nonfunctional blind intestinal loop (group A) or a functional intestinal loop of the gastrointestinal tract (group B). A spindle-shaped curved, rigid, low density polyethylene (LDPE) splint was sutured on the external surface of the patch in order to prevent shrinkage of GWF and collapse of the intestinal wall in group A.Results: There was a decrease of both dimensions of the patch. Microscopically a thin layer of columnar epithelial cells covered the center of the patch, evolving in shorter, blunt, poorly developed villi with increasing maturation laterally. The patch surface was covered by nearly 90%. In the three animals that died prematurely the coverage of GWF was negligent or suboptimal directly dependent on the length of survival.Conclusions: The hereby-described patching technique demonstrated the growth of intestinal neomucosa on the GWF. The capability of the stomach to provide large flaps and the advantages of the use of native tissues render this animal model valuable for the future research in the field.
{"title":"Growth of Intestinal Neomucosa on Pedicled Gastric Wall Flap, a Novel Technique in an Animal Model.","authors":"Panagiotis Sakarellos, Apostolos Papalois, Harikleia Gakiopoulou, Iro Zacharioudaki, Michalis Katsimpoulas, Marina Belia, Dimitrios Moris, Kyveli Aggelou, Ilias Vagios, Spiridon Davakis, Michail Vailas, Theodoros Liakakos, Theodoros Diamantis, Evangelos Felekouras, Michael Kontos","doi":"10.1080/08941939.2022.2034196","DOIUrl":"https://doi.org/10.1080/08941939.2022.2034196","url":null,"abstract":"<p><p><b>Background:</b> Short bowel syndrome (SBS) remains an unsolved issue in modern medicine. Numerous experimental surgical techniques have been proposed in the attempt to increase the intestinal absorptive capacity.<b>Materials and Methods:</b> Ten female Landrace pigs, divided in two groups of 5 (A and B), were explored through a midline incision. A spindle-shaped vascularized full-thickness gastric wall flap (GWF) consisting of part of the major curvature with the gastroepiploic arch preserved was de-epithelialized and then placed as a \"patch\" to cover an antimesenteric border defect of either a nonfunctional blind intestinal loop (group A) or a functional intestinal loop of the gastrointestinal tract (group B). A spindle-shaped curved, rigid, low density polyethylene (LDPE) splint was sutured on the external surface of the patch in order to prevent shrinkage of GWF and collapse of the intestinal wall in group A.<b>Results:</b> There was a decrease of both dimensions of the patch. Microscopically a thin layer of columnar epithelial cells covered the center of the patch, evolving in shorter, blunt, poorly developed villi with increasing maturation laterally. The patch surface was covered by nearly 90%. In the three animals that died prematurely the coverage of GWF was negligent or suboptimal directly dependent on the length of survival.<b>Conclusions:</b> The hereby-described patching technique demonstrated the growth of intestinal neomucosa on the GWF. The capability of the stomach to provide large flaps and the advantages of the use of native tissues render this animal model valuable for the future research in the field.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 6","pages":"1329-1339"},"PeriodicalIF":1.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39947252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2022-01-17DOI: 10.1080/08941939.2021.2025282
Otto Tolvanen, Antti-Pekka Elomaa, Matti Itkonen, Hana Vrzakova, Roman Bednarik, Antti Huotarinen
BackgroundEye tracking is a powerful tool for unobtrusive and real time assessment of workload in clinical settings. Before the complex eye tracking derived surrogates can be proactively utilized to improve surgical safety, the indications, validity and reliability requires careful evaluation.MethodsWe conducted a systematic review of literature from 2010 to 2020 according to PRISMA guidelines. A search on PubMed, Cochrane, Scopus, Web of science, PsycInfo and Google scholar databases was conducted on July 2020. The following search query was used" ("eye tracking" OR "gaze tracking") AND (surgery OR surgical OR operative OR intraoperative) AND (workload OR stress)". Short papers, no peer reviewed or papers in which eye-tracking methodology was not used to investigate workload or stress factors in surgery, were omitted.ResultsA total of 17 (N = 17) studies were identified eligible to this review. Most of the studies (n = 15) measured workload in simulated setting. Task difficulty and expertise were the most studied factors. Studies consistently showed surgeon's eye movements such as pupil responses, gaze patterns, blinks were associated with the level of perceived workload. However, differences between measurements in operational room and simulated environments have been found.ConclusionPupil responses, blink rate and gaze indices are valid indicators of workload. However, the effect of distractions and non-technical factors on workload is underrepresented aspect in the literature even though recognized as underlying factors in successful surgery.
眼部跟踪是一种强大的工具,用于临床设置中不显眼和实时的工作量评估。在积极利用复杂眼动追踪衍生替代物提高手术安全性之前,需要仔细评估其适应症、有效性和可靠性。方法根据PRISMA指南对2010 ~ 2020年的文献进行系统综述。2020年7月对PubMed、Cochrane、Scopus、Web of science、PsycInfo和Google scholar数据库进行了检索。使用以下搜索查询“(“眼动追踪”或“凝视追踪”)和(手术或手术或手术或术中)和(工作量或压力)”。简短的论文、没有经过同行评审的论文或没有使用眼动追踪方法来调查手术中的工作量或压力因素的论文被省略。结果共有17项(N = 17)研究被纳入本综述。大多数研究(n = 15)在模拟环境中测量工作量。任务难度和专业知识是研究最多的因素。研究一致表明,外科医生的眼球运动,如瞳孔反应、凝视模式、眨眼等,与感知到的工作量水平有关。然而,在操作室和模拟环境测量之间的差异已经被发现。结论瞳孔反应、眨眼频率和凝视指标是有效的工作负荷指标。然而,尽管被认为是手术成功的潜在因素,但分心和非技术因素对工作量的影响在文献中被低估。
{"title":"Eye-Tracking Indicators of Workload in Surgery: A Systematic Review.","authors":"Otto Tolvanen, Antti-Pekka Elomaa, Matti Itkonen, Hana Vrzakova, Roman Bednarik, Antti Huotarinen","doi":"10.1080/08941939.2021.2025282","DOIUrl":"https://doi.org/10.1080/08941939.2021.2025282","url":null,"abstract":"<p><p>BackgroundEye tracking is a powerful tool for unobtrusive and real time assessment of workload in clinical settings. Before the complex eye tracking derived surrogates can be proactively utilized to improve surgical safety, the indications, validity and reliability requires careful evaluation.MethodsWe conducted a systematic review of literature from 2010 to 2020 according to PRISMA guidelines. A search on PubMed, Cochrane, Scopus, Web of science, PsycInfo and Google scholar databases was conducted on July 2020. The following search query was used\" (\"eye tracking\" OR \"gaze tracking\") AND (surgery OR surgical OR operative OR intraoperative) AND (workload OR stress)\". Short papers, no peer reviewed or papers in which eye-tracking methodology was not used to investigate workload or stress factors in surgery, were omitted.ResultsA total of 17 (N = 17) studies were identified eligible to this review. Most of the studies (<i>n</i> = 15) measured workload in simulated setting. Task difficulty and expertise were the most studied factors. Studies consistently showed surgeon's eye movements such as pupil responses, gaze patterns, blinks were associated with the level of perceived workload. However, differences between measurements in operational room and simulated environments have been found.ConclusionPupil responses, blink rate and gaze indices are valid indicators of workload. However, the effect of distractions and non-technical factors on workload is underrepresented aspect in the literature even though recognized as underlying factors in successful surgery.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 6","pages":"1340-1349"},"PeriodicalIF":1.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39689951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2022-01-06DOI: 10.1080/08941939.2021.2024307
Suleyman Gunhan Doluoglu, Mehmet Karaca, Onur Erol
Background: The role of Ca-125 in endometrial cancer is not fully known. Some authors have reported high Ca-125 levels in patients with recurrent or advanced endometrial cancer, whereas others have stated that Ca-125 levels and the advance of the disease were not correlated in endometrial cancer. This makes it inevitable for clinicians to search for different measurement methods or interpretation of the present tumor markers. The aim of this study was to evaluate the relationship between Ca-125 values of the serum and abdominal lavage fluid and postoperative histopathological parameters in patients with endometrial carcinoma.
Methods: The study included patients who were diagnosed with endometrial cancer in the Gynecology Clinic and were planned to undergo surgery. The correlations of clinicopathological parameters with preoperative values of Ca-125 measured from serum and abdominal lavage fluid were investigated. The Spearman correlation test was applied in the analysis of correlations of serum and abdominal lavage fluid Ca-125 values with postoperative tumor characteristics.
Results: The serum Ca-125 values were determined to be positively correlated with surgical stage, tumor diameter, and lymph node involvement (p = 0.03; p = 0.04; and p = 0.01, respectively). No correlation was determined between tumor grade and serum Ca-125 level. The level of Ca-125 in the abdominal lavage fluid was observed to be correlated with surgical stage and tumor grade, but not with tumor diameter or lymph node involvement (p = 0.01, p = 0.04, respectively).
Conclusions: The value of Ca-125 in the abdominal lavage fluid has a positive correlation with the surgical stage and tumor grade in patients with endometrial carcinoma.
{"title":"Correlation of Preoperative Serum and Intraoperative Peritoneal Lavage Fluid Ca-125 Levels with Postoperative Tumor Histology in Patients with Endometrial Cancer: A Prospective-Controlled Study.","authors":"Suleyman Gunhan Doluoglu, Mehmet Karaca, Onur Erol","doi":"10.1080/08941939.2021.2024307","DOIUrl":"https://doi.org/10.1080/08941939.2021.2024307","url":null,"abstract":"<p><strong>Background: </strong>The role of Ca-125 in endometrial cancer is not fully known. Some authors have reported high Ca-125 levels in patients with recurrent or advanced endometrial cancer, whereas others have stated that Ca-125 levels and the advance of the disease were not correlated in endometrial cancer. This makes it inevitable for clinicians to search for different measurement methods or interpretation of the present tumor markers. The aim of this study was to evaluate the relationship between Ca-125 values of the serum and abdominal lavage fluid and postoperative histopathological parameters in patients with endometrial carcinoma.</p><p><strong>Methods: </strong>The study included patients who were diagnosed with endometrial cancer in the Gynecology Clinic and were planned to undergo surgery. The correlations of clinicopathological parameters with preoperative values of Ca-125 measured from serum and abdominal lavage fluid were investigated. The Spearman correlation test was applied in the analysis of correlations of serum and abdominal lavage fluid Ca-125 values with postoperative tumor characteristics.</p><p><strong>Results: </strong>The serum Ca-125 values were determined to be positively correlated with surgical stage, tumor diameter, and lymph node involvement (p = 0.03; p = 0.04; and p = 0.01, respectively). No correlation was determined between tumor grade and serum Ca-125 level. The level of Ca-125 in the abdominal lavage fluid was observed to be correlated with surgical stage and tumor grade, but not with tumor diameter or lymph node involvement (p = 0.01, p = 0.04, respectively).</p><p><strong>Conclusions: </strong>The value of Ca-125 in the abdominal lavage fluid has a positive correlation with the surgical stage and tumor grade in patients with endometrial carcinoma.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 6","pages":"1248-1252"},"PeriodicalIF":1.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39790421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01Epub Date: 2022-01-30DOI: 10.1080/08941939.2022.2032488
Verónica Custodio, Jorge Acosta, Carmen Rubio, Leonardo Hernández, Javier Brito, Elisa Taddei
This article describes in detail the essential stereotaxic neurosurgery to develop the electric experimental kindling model in mice. To date, available literature describing the methodology of the kindling model is very poor and usually neglects many relevant details about the neurosurgery, such as the manufacture of the electrodes, accurate stereotaxic coordinates of the amygdala nuclei, and the general surgery procedures (e.g., anesthesia, postsurgical recovery, fit survival of the animal's). The electric kindling model produces a progressive development of generalized tonic-clonic seizures, which can be assessed by electroencephalography and behavioral responses. The seizures displayed are produced by a repeated low-intensity electrical stimulation in specific regions of the brain that is achieved through the previous implantation of electrodes. In this study, the aim was to implant the electrodes in basolateral amygdaloid nucleus (BLA). In order to successfully establish the kindling experimental model, neurosurgery to place the electrodes is an essential step to develop the epileptogenic phenomenon. It crucial that the surgery is carried out with exceptional exactitude, because in that way the experimental model represents an accurate and valid tool to study and understand epilepsy and the results obtained can be used to develop further strategies in epilepsy clinical research.
{"title":"Accurate Neurosurgery for the Establishment of the Electric Kindling Model of Epilepsy in Mice.","authors":"Verónica Custodio, Jorge Acosta, Carmen Rubio, Leonardo Hernández, Javier Brito, Elisa Taddei","doi":"10.1080/08941939.2022.2032488","DOIUrl":"https://doi.org/10.1080/08941939.2022.2032488","url":null,"abstract":"<p><p>This article describes in detail the essential stereotaxic neurosurgery to develop the electric experimental kindling model in mice. To date, available literature describing the methodology of the kindling model is very poor and usually neglects many relevant details about the neurosurgery, such as the manufacture of the electrodes, accurate stereotaxic coordinates of the amygdala nuclei, and the general surgery procedures (e.g., anesthesia, postsurgical recovery, fit survival of the animal's). The electric kindling model produces a progressive development of generalized tonic-clonic seizures, which can be assessed by electroencephalography and behavioral responses. The seizures displayed are produced by a repeated low-intensity electrical stimulation in specific regions of the brain that is achieved through the previous implantation of electrodes. In this study, the aim was to implant the electrodes in basolateral amygdaloid nucleus (BLA). In order to successfully establish the kindling experimental model, neurosurgery to place the electrodes is an essential step to develop the epileptogenic phenomenon. It crucial that the surgery is carried out with exceptional exactitude, because in that way the experimental model represents an accurate and valid tool to study and understand epilepsy and the results obtained can be used to develop further strategies in epilepsy clinical research.</p>","PeriodicalId":16200,"journal":{"name":"Journal of Investigative Surgery","volume":"35 6","pages":"1253-1262"},"PeriodicalIF":1.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39870845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}