Leukopenia is an independent risk factor for early postoperative complications following incision and drainage of anorectal abscess

Risk factors and outcomes after surgery for malignant neoplasm of the parotid gland: An ACS-NSQIP study

BACKGROUND

Malignant neoplasms of the parotid gland (MPG) are clinically challenging due to aggressive growth and metastasis. Despite tumor resection being the primary treatment, there is a paucity of studies on postsurgical outcomes and preoperative risk factors for MPG.

MATERIALS AND METHODS

We queried the American College of Surgeons National Surgical Quality Improvement Program database to identify patients who underwent MPG surgery between 2008 and 2021. 30-day postoperative outcomes and risk factors predisposing to the occurrence of complications were assessed.

RESULTS

The study population included 3052 patients, the majority of whom were males (n = 1842; 60%) and White (n = 2017; 66%). The average age was 63 ± 16 years. The most common comorbidities were obesity (n = 1182; 39%) and hypertension (n = 1533; 50%). Surgical procedures were performed predominantly in the inpatient setting (n = 1773; 58%) by ENT surgeons (n = 2767; 91%). Overall, complications were reported in 6.8% (n = 209) of patients. Inpatient setting (p < 0.001), renal failure (p < 0.001), smoking (p = 0.012), as well as increased creatinine (p < 0.001) and blood urea nitrogen (BUN) levels (p = 0.001) were identified as risk factors for complications. In addition, concurrent microsurgical procedures such as flap surgery and/or nerve grafting significantly increased the risk of postoperative adverse events (p < 0.001).

CONCLUSIONS

Our analysis revealed that complication rates were associated with high creatinine and BUN levels, inpatient surgery, renal failure, higher American Society of Anesthesiology classes, and smoking. We also found that concurrent microsurgical procedures were predictive factors for complications. These findings can inform patient counseling, preoperative planning, and risk stratification.

Targeting CD38/ ADP-ribosyl cyclase as a novel therapeutic strategy for identification of three potent agonists for leukopenia treatment

Leukopenia is the most common side effect of chemotherapy and radiotherapy. It potentially deteriorates into a life-threatening complication in cancer patients. Despite several agents being approved for clinical administration, there are still high incidences of pathogen-related disease due to a lack of functional immune cells. ADP-ribosyl cyclase of CD38 displays a regulatory effect on leukopoiesis and the immune system. To explore whether the ADP-ribosyl cyclase was a potential therapeutic target of leukopenia. We established a drug screening model based on an ADP-ribosyl cyclase-based pharmacophore generation algorithm and discovered three novel ADP-ribosyl cyclase agonists: ziyuglycoside II (ZGSII), brevifolincarboxylic acid (BA), and 3,4-dihydroxy-5-methoxybenzoic acid (DMA). Then, in vitro experiments demonstrated that these three natural compounds significantly promoted myeloid differentiation and antibacterial activity in NB4 cells. In vivo, experiments confirmed that the compounds also stimulated the recovery of leukocytes in irradiation-induced mice and zebrafish. The mechanism was investigated by network pharmacology, and the top 12 biological processes and the top 20 signaling pathways were obtained by intersecting target genes among ZGSII, BA, DMA, and leukopenia. The potential signaling molecules involved were further explored through experiments. Finally, the ADP-ribosyl cyclase agonists (ZGSII, BA, and DMA) has been found to regenerate microbicidal myeloid cells to effectively ameliorate leukopenia-associated infection by activating CD38/ADP-ribosyl cyclase-Ca2+-NFAT. In summary, this study constructs a drug screening model to discover active compounds against leukopenia, reveals the critical roles of ADP-ribosyl cyclase in promoting myeloid differentiation and the immune response, and provides a promising strategy for the treatment of radiation-induced leukopenia.

Differences in Gut Microbiota between Healthy Individuals and Patients with Perianal Abscess before and after Surgery

Surgery is the most important treatment for perianal abscesses. However, the gut microbiota of patients with perianal abscess and the effects of perianal abscess on the gut microbiota after surgery are unknown. In this study, significant changes in interleukin 6 and tumor necrosis factor-α in the blood of healthy subjects, patients with perianal abscesses, and patients after perianal abscess surgery were identified. 16S rRNA gene sequencing technology was used to detect the changes in the gut microbiota among 30 healthy individuals and 30 patients with perianal abscess before and after surgery. Venn diagrams and alpha diversity analyses indicated differences in the abundance and uniformity of gut microbiota between the healthy individuals and patients with perianal abscesses before and after surgery. Beta diversity analysis indicated that the grouping effects among the control, abscess, and surgery groups were good. The classification and compositional analysis showed significant differences in the gut microbiota between healthy individuals and patients with perianal abscesses before and after surgery. LEfSe analysis, random forest analysis, and ROC curve analysis showed that Klebsiella (AUC = 0.7467) and Bilophila (AUC = 0.72) could be potential biomarkers for the diagnosis of perianal abscess. The functional prediction results showed that the differential microbiota is significantly enriched in the pathways related to nutrition and drug metabolism. This study may have important implications for the clinical management and prognostic assessment of patients with perianal abscesses.