Annals of Medicine and Surgery最新文献

Background and objective: Exosomes have been confirmed to be implicated in the pathogenesis of calcium oxalate (CaOx) stones. tRNA-derived small RNAs (tsRNAs) are among the oldest small RNAs involved in exosome-mediated intercellular communication, yet their role in kidney stones remains unexplored. This pilot study aimed to identify differentially expressed tsRNAs (DEtsRNAs) in urine exosomes between CaOx stone patients and healthy controls and explore their potential roles in nephrolithiasis.

Method: First-morning urine samples were collected from three CaOx stone patients and three healthy controls. Urinary exosomes were isolated and analyzed by high-throughput sequencing to generate the expression profiles of tsRNAs and detect DEtsRNAs. Predicted target genes of DEtsRNAs were subjected to functional enrichment analysis. The authors also combined the public dataset GSE73680 to investigate how DEtsRNAs were related to stone formation.

Results: Four DEtsRNAs were significantly upregulated in CaOx stone patients compared to healthy controls. tRF-Lys-TTT-5005c was the most elevated, followed by tRF-Lys-CTT-5006c, tRF-Ala-AGC-5017b, and tRF-Gly-CCC-5004b. Bioinformatics analysis indicated that these four types of DEtsRNAs might serve distinct biological functions. Combined with data mining from the public dataset GSE73680, the authors assumed that exosomes carrying tRF-Lys-TTT-5005c and tRF-Lys-CTT-5006c could inhibit the expression of SMAD6, FBN1, and FZD1, thereby activating the BMP signaling pathway, which might induce an osteogenic-like transformation in target cells, resulting in the formation of Randall's plaques and CaOx stones.

Conclusion: The authors' findings shed light on the potential roles of tsRNAs in the pathogenesis of CaOx stone disease, highlighting exosomal DEtsRNAs as promising diagnostic biomarkers and therapeutic targets in nephrolithiasis.

Background: Familial hypercholesterolemia (FH), an autosomal dominant disease, is associated with an increased risk of premature cardiovascular disease (CVD). This study aimed to examine the variations in serum levels of calcium, vitamin D, phosphorus, and parathyroid hormone (PTH) among FH patients, as these factors have been associated with an increased susceptibility to CVD.

Materials and methods: In this cross-sectional study, the authors used data from Isfahan FH registry. The Dutch Lipid Clinic Network (DLCN) criteria was used for diagnoses of FH patients. Control group included participants with hyperlipidemia and were unlikely FH according to DLCN criteria. All biochemical parameters were measured using standard methods.

Results: A total of 131 patients (mean age, 53.1 ± 12.2; male, 51.4%) were included in the analysis. Patients with FH had lower serum vitamin D levels compared with control groups in the unadjusted model (P= 0.028). The relationship between serum vitamin D and FH was not significant after adjustment for traditional risk factor (P= 0.184). No significant association was observed between FH and serum calcium (P= 0.886), phosphorus (P= 0.463), and PTH (P= 0.849). Besides, there was no significant association between LDL-C or total cholesterol and serum minerals in FH patients.

Conclusion: This study found no significant changes in serum calcium, vitamin D, phosphorus, and PTH in patients with FH.

Introduction: Melanoma, a malignant tumor derived from neural crest melanocytes, predominantly affects the skin but can involve any organ with neural crest migration. Metastatic melanoma of unknown origin, particularly when it involves the brain, is associated with significant morbidity, mortality, and a typically poor prognosis.

Case presentation: The authors present a 71-year-old man with a history of hypertension and seizure disorder who experienced a headache, transient loss of consciousness, and vomiting. Imaging revealed a mass with perilesional edema in the right temporal, right occipital, left frontal, and left periventricular regions. A craniotomy and excision of the right temporal lesion confirmed malignant metastatic melanoma through histological examination. Despite normal findings in skin, mucosal, anogenital, and ophthalmological examinations, and a comprehensive CT scan of the chest, abdomen, and pelvis that revealed no primary tumor, the diagnosis of metastatic melanoma of unknown origin was made. The patient did not receive treatment due to financial constraints.

Clinical discussion: About 2-6% of melanoma patients present with tumors of unknown primary origin. Brain metastases occur in ~60% of advanced melanoma cases and carry a high risk of spontaneous bleeding. While traditional survival rates are low, surgical resection, stereotactic radiosurgery, immunotherapy, and BRAF/MEK inhibitors can improve outcomes.

Conclusion: Headaches, lethargy, vomiting, and altered sensorium should prompt investigation for brain metastases from melanoma, even without a detectable primary tumor. Treatment strategies including immunotherapy and stereotactic surgery aim for a median survival of 8-10 months. Socio-economic factors, as highlighted in this case, significantly affect treatment access and patient outcomes.

Radiotherapy is widely regarded as the primary therapeutic modality for nasopharyngeal cancer (NPC). Studies have shown that cancer cells with high resistance to radiation, known as radioresistant cancer cells, may cause residual illness, which in turn might contribute to the occurrence of cancer recurrence and metastasis. It has been shown that cancer stem-like cells (CSCs) exhibit resistance to radiation therapy. In the present study, fractionated doses of radiation-induced epithelial-mesenchymal transition (EMT) and ALDH+ CSCs phenotype of NPC tumor spheroids. Furthermore, it has been shown that cells with elevated ALDH activity have increased resistance to the effects of fractionated irradiation. Nuclear factor erythroid-2-related factor 2 (Nrf2) plays a pivotal role in regulating cellular antioxidant systems. A large body of evidence suggests that Nrf2 plays a significant role in the development of radioresistance in cancer. The authors' research revealed that the application of fractionated irradiation resulted in a decline in Nrf2-dependent reactive oxygen species (ROS) levels, thereby mitigating DNA damage in ALDH+ stem-like NPC cells. In addition, immunofluorescence analysis revealed that subsequent to the process of fractionated irradiation of ALDH+ cells, activated Nrf2 was predominantly localized inside the nucleus. Immunofluorescent analysis also revealed that the presence of the nuclear Nrf2+/NQO1+/ALDH1+ axis might potentially serve as an indicator of poor prognosis and resistance to radiotherapy in patients with NPC. Thus, the authors' findings strongly suggest that the radioresistance of ALDH-positive NPC CSCs to fractionated irradiation is regulated by nuclear Nrf2 accumulation. Nrf2 exerts its effects through the downstream effector NQO1/ALDH1, which depends on ROS attenuation.

Background: As one domain of preoperative assessment, preoperative investigations are often ordered to evaluate patient's medical condition for risk stratification and assessing patient status to undergoing surgery. Despite the fact that laboratory testing can assist in ensuring the best possible preoperative condition, routine screening examinations have a number of drawbacks. Although there are evidence-based recommendations for which investigations should be done, the tradition of routine preoperative testing is still prevalent and clinical practice with abnormal results detected varies.

Method: Institution-based cross-sectional study design was conducted from 1 November to January at Dilla University Referral Hospital. Data was collected from complete pre-anaesthesia check-up sheets, investigations already done. It was collected at the individual level by using, closed-ended self-guided questionnaire. The collected data was entered, cleaned, edited and checked using SPSS version 26 for data processing and analysis. Logistic regression was performed to examine the impacts of abnormal preoperative investigation results and summarised by using tables and figures. An Adjusted odds ratio with 95% CI was computed to determine the level of significance.

Result: Data of 208 patients (65.9 female) with mean±standard deviation age 30.83±15.340 years and 22.59±2.99 BMI were analysed. Patients were mostly American Society of Anaesthesiologists I and II underwent National Institute of Clinical and Health Excellence Grade 2 surgeries and surgical shape class 3. Totally, 178 (44.5%) test results were abnormal. CBC is the most detected abnormal result. Only 15 (3.75%) abnormalities had an impact in terms of delay, further investigations, and surgical technique. Comorbidity (AOR 7.982, 95% CI, P=0.041), medication history (AOR 1.463, 95% CI, P=0.013), ASA physical status II (AOR 3.287, 95% CI, P=0.029) and history of smoking (AOR 1.577, 95% CI, P=0.049) were factors which was significantly associated with abnormal preoperative investigation result.

Conclusion: Only 0.6% of all tests had a significant impact in terms of changing perioperative anaesthetic management. The significant impact of abnormal investigation result noticed was delayed surgery.

Introduction: Robotic-assisted surgery (RAS) is one of the most influential surgical advances with widespread clinical and health-economic benefits. West Hertfordshire Teaching Hospital NHS Trust was the first in the UK to simultaneously integrate two CMR Surgical Versius robots. This study aims to investigate clinical outcomes of RAS, explore surgeon learning curves and assess the feasibility of implementation within a district general hospital (DGH).

Methods: A prospective cohort study of 100 consecutive patient data were collected between July 2022 and August 2023, including demographics, operative and clinical variables, and compared with laparoscopic surgery (LS) data from the National Bowel Cancer Audit. Surgeon learning curves were analysed using sequential surgical and console times.

Results: In the RAS cohort, the median age was 70 (IQR 57-78 years) and 60% were male. Retrieval of a minimum of 12 lymph nodes significantly increased in RAS compared to LS (95% vs. 88%, P=0.05). The negative mesorectal margin rate was similar between RAS and LS (97% vs. 91%, P=0.10), as well as length of stay greater than 5 days (42% vs. 39%, P=0.27). For anterior resections performed by the highest volume surgeon (n=16), surgical time was reduced over 1 year by 35% (304.9-196.9 min), whilst console time increased by 111% (63.0-132.8 min).

Conclusions: Key quality performance indicators were either unchanged or improved with RAS. There is potential for improved theatre utilisation and cost-savings with increased RAS. This study demonstrates the feasibility and easy integration of robotic platforms into DGHs, offering wider training opportunities for the next generation of surgeons.

Background: Pain resulting from therapeutic procedures and injections is a prevalent source of stress for children. Immediate side effects of pain in infants include syncope, irritability, sleep disturbances, and nutritional issues. This study aimed to investigate the effects of oral melatonin on alleviating pain and anxiety in pediatric patients undergoing venipuncture.

Methods: This double-blind, randomized controlled trial was conducted in the pediatric emergency ward. Patients were randomly assigned to one of two groups; the intervention group received 0.5 mg/kg of oral melatonin (maximum 5 mg) 30 min before venipuncture, while the placebo group received an equivalent amount of a placebo 30 min before the procedure. Using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, postcanulation fear, pain severity, compliance, and potential side effects were evaluated.

Results: In total, 202 patients (113 male and 89 female) in the intervention and control groups were included in the analysis. The mean pain score during venipuncture was 1.52±3.04 in the intervention group and 2.04±6.57 in the control group (P<0.001). In the intervention group, only 19 (18.8%) patients reported pain during venipuncture, whereas 79 (78.2%) patients in the control group reported pain (P<0.001). Less than half (44.6%) of the patients in the intervention group experienced anxiety during venipuncture, while the majority (94.1%) of the patients in the control group exhibited anxiety (P<0.001). The venipuncture success rate was 60.4% in the intervention group and 51.5% in the control group (P=0.257).

Conclusion: Administering 0.5 mg/kg of oral Melatonin 30 min before venipuncture reduces procedure-related pain and anxiety in pediatric patients and may be associated with higher venipuncture success rates.