Anastomosis selection in liver transplantation for recipients with unusable recipient hepatic arteries: a bayesian network meta-analysis

BACKGROUND

The anastomosis of donor and recipient hepatic arteries is standard in liver transplantations. For transplant recipients with unusable hepatic arteries, appropriate artery selection should be conducted using evidence-based considerations; therefore, this network meta-analysis (NMA) aimed to analyze the most suitable alternative recipient artery for anastomosis during liver transplantations.

METHODS

Comprehensive searches of the Scopus, Cochrane Library, and MEDLINE databases were conducted to analyze observational studies containing non-standard anastomoses in liver transplantations that used the splenic artery, aorta, celiac, or branches of the gastric artery. The outcome parameters included intraoperative components, complications, and survival data. This NMA used the BUGSnet package in R studio and the results were presented in a Forest plot, league table, and SUCRA plot.

RESULTS

Among the 13 studies included in this NMA, 5 arteries were used for the anastomoses. The splenic artery anastomosis showed a high risk of thrombosis and a low risk of stenosis (OR 1.12, 95% CI 0.13-3.14) and biliary tract abnormalities (OR 0.79, 95% CI 0.36-1.55). In addition, the graft survival (OR 1.08; 95% CI 0.96-1.23) and overall survival (1-year survival OR 1.09, 95% CI 0.94-1.26; 5-year survival OR 1.95% CI 0.83-1.22) showed favorable results using this artery. Constraints to the use of the splenic artery were longer operation and cold ischemic times. However, the duration of hospital stay (MD 1.36, 95% CI -7.47 to 10.8) was shorter than that when the other arteries were used, and the need for blood transfusions was minimal (MD -1.74, 95% CI -10.2 to 6.7).

CONCLUSION

In recipients with unusable hepatic arteries, the splenic artery of the patient should be the first consideration for anastomosis selection in liver transplantations.

The Mutation Portraits of Oncogenes and Tumor Supressor Genes in Predicting the Overall Survival in Pancreatic Cancer: A Bayesian Network Meta-Analysis

INTRODUCTION

In pancreatic cancer, the carcinogenesis can not be separated from genetics mutations. The portraits of genes alterations majorily including oncogenes (KRAS, HER2, PD-L1) and tumor supressor genes (P53, CDKN2A, SMAD4). Besides being notorious a screening marker, the genetic mutations were related to the prognosis of pancreatic cancer. The aim of this study is to determine the genetic mutations portrait in predicting the overall survival in pancreatic cancer.

METHODS

The network meta analysis (NMA) was registered in PROSPERO (CRD42023397976) and conducted in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) in addition of NMA extension guidance. Comprehensive searches were done including all studies which reported the overall survival of pancreatic cancer subjects with KRAS, HER2, PD-L1, P53, CDKN2A, SMAD4. Data were collected and analysis will be done based on Bayesian method, Markov Chain Monte Carlo algorithm, using BUGSnet package in R studio. Transivity was controlled by methods and consistency of the NMA will be fitted by deviance information criterion. Data analysis in NMA were presented in Sucra plot, league table, and forest plot.

RESULTS

Twenty-four studies were included in this NMA with 4613 total subjects. The NMA was conducted in random-effects, consistent, and convergence model. Relative to control, the genetic mutation of SMAD4 (HR 1.84; 95%CI 1.39-2.46), HER2 (HR 1.76; 95%CI 1.14-2.71), and KRAS (HR 1.7; 95%CI 1.19-2.48) were significant to have worse survival. The mutations of PD-L1, P53, and CDKN2A also showed poor survival, but not statistically significant compared to control.

CONCLUSION

In pancreatic cancer, the mutation of SMAD4 predicted the worst overall survival, compared to control, also mutation of HER2, KRAS, PD-L1, P53, and CDKN2A.

The neuroprotective effect of statin in traumatic brain injury: A systematic review

Despite recent encouraging pharmaceutical and technical breakthroughs in neurosurgical critical care, traumatic brain injury (TBI)-related mortality and morbidity remain substantial clinical issues. Medication of statins was revealed to enhance outcomes following TBI in animal research. In addition to their main role of decreasing serum cholesterol, statins decrease inflammation and enhance cerebral blood flow. However, research on the efficacy of statins in TBI is still limited. This systematic review was conducted to determine the efficacy of statins in enhancing the clinical outcomes of TBI individuals, and specifically investigate the optimal dose and form of statins. The databases of PubMed, DOAJ, EBSCO, and Cochrane were extensively researched. The date of publication within the last fifteen years was the inclusion criterion. Meta-analyses, clinical trials, and randomized controlled trials were prioritized forms of research publications. Ambiguous remarks, irrelevant correlations to the main issue, or a focus on disorders other than TBI were the exclusion criteria. Thirteen research were included in this study. Simvastatin, atorvastatin, and rosuvastatin were the main form of statins discussed in this study. Enhancement of the Glasgow Coma Scale, survival rates, hospital length of stay, and cognitive outcomes were revealed in this study. This study suggests either simvastatin 40 mg, atorvastatin 20 mg, or rosuvastatin 20 mg for 10 days as the optimal therapeutic forms and doses to be applied in the management of TBI. Pre-TBI statin use was linked to lower risk of mortality in TBI individuals compared to nonusers, whereas statin discontinuation was linked to an increase in mortality.

A Bayesian Network Meta-Analysis Comparing Biliary Stent Types' Outcome and Complications in Unresectable Malignant Biliary Obstructions

OBJECTIVE

To conduct a network meta-analysis (NMA) in comparing biliary stents types' outcomes and complications in unresectable MBO.

METHODS

The study was conducted in accordance with the PRISMA and NMA extension . Comprehensive searches of the Cochrane Library, MEDLINE, and Scopus were done analyzing randomized controlled trials that included subjects with unresectable malignant biliary obstructions that underwent biliary stents placement from any approaches. The types of stents that included were full-covered metal (FMS), partially-covered metal (PMS), uncovered metal (UMS), plastic (PLS), Iodine-125 seeds strands (IRS), antireflux (ARS), and paclitaxel-coated (PXS) stents. The outcome parameters were clinical success, median patency duration, medial survival, and early 30-day mortality. The complications included were stent occlusion, stent migration, cholangitis, cholecystitis, pancreatitis, hemorrhage, and hemobilia. The NMA will be done based on Bayesian method, Markov Chain Monte Carlo algorithm, using BUGSnet package in R studio. Transivity was controlled by methods and consistency of the NMA will be fitted by deviance information criterion. Data analysis in NMA were presented in Sucra plot, league table, and forest plot.

RESULT

Thirty-six RCTs were included with 3502 subjects. ARS had the best clinical success and longest median patency. However, it was associated with higher rate of  complications. IRS had a good clinical success (RR 1.63; 95%CI 0.67-6.25), long median patency (MD 21.14; 95%CI -106.18 to 145.91), and high significant survival rate (MD 69.89; 95%CI 22 to 117.57) compared to others stents. It was associated unsignificant complications of cholecystitis, hemobilia, and hemorrhage.

CONCLUSION

Iodine-125 seeds strands had the promising good outcome and tolerated complications among others and should be considered as a standard stent to be used in unresectable malignant biliary obstructions.

Epidemiological Trend Analysis and Survival Data of Balinese with Soft-Tissue Sarcoma in 2015–2021

BACKGROUND: Soft tissue sarcoma (STS) has a very heterogen features of its nature, subtypes, and clincial behaviour among population. Regardless, the epidemiology data of soft tissue sarcoma is very limited in developing countries, including Indonesia. AIM: To decribe the incidence and mortality trend analysis, as long as the survival data in Bali from 2015 to 2020. METHODS: This is a case control study including all subjects with STS in Denpasar, Bali, Indonesia from January 2015 to September 2021. Data about demographics, clinical, and survival timing data were collected from Cancer Registry. Soft tissue sarcoma diagnosis was confirmed after histopathological examination. Joinpoint regression was used for crude rate trend analysis. Data was analyzed by SPSS 22.0, using Kaplan-Meier for survival analysis. RESULTS: Ninety three subjects with STS were included in this study. Most patients died at the end of the study (65.6%) with median survival of only 30 months. The trend of STS age-standardized incidence and mortality rate was increasing from 2015 to 2018, then declining until 2020. The survival rate varies among the soft tissue sarcoma subtypes and location. It was better in the group without metastases, underwent therapy, but not statistically significant. CONCLUSION: Soft tissue sarcoma showed a diversity of demographic and clinical parameters. The incidence and mortality rate has plateued in 2018, but then declining. The survival rate diversed regarding of the STS subtype, location, metastasis, and treatment given.

The Baseline, Clinical, and Laboratory Parameters of Breast Cancer Subjects Infected with COVID-19 in Medan, Indonesia

BACKGROUND: Cancer patients may be susceptible to COVID-19 infection due to decreased immune status. Breast cancer is the most common cancer in Indonesia, still has high admission, which increasing the risk of exposure to COVID-19. AIM: Thus, this study aimed to identify hospitalized breast cancer patients diagnosed with COVID-19 infection 1 year after the pandemic. METHODS: This is a cross-sectional study that was conducted in the Adam Malik General Hospital in Medan, Sumatera Utara, Indonesia. The enrolled subjects were those who previously histopathologically confirmed with breast cancer and having laboratory-confirmed COVID-19 infection The sources of baseline, clinical, and laboratory data were retrieved from the electronic medical records. Statistical analysis was performed using the SPSS 16.0 software (SPSS Inc., Chicago, IL, USA). RESULTS: A total of 17 female breast cancer subjects with COVID-19 infection were enrolled in this study. Mostly subjects were multiparity, highest education was junior high school, housewife, menopause, diagnosed in Stage IV, had metastasis in lung, and categorized luminal B with invasive cancer of non-special type. Most subjects showed mild clinical and radiological severity of COVID-19 infection. Low leukocyte, high neutrophil-to-lymphocyte, and high platelet-to-lymphocyte counts were significantly differed between alive and death outcome in the subjects. CONCLUSION: The baseline and clinical characteristics of female breast cancer subjects with COVID-19 infection were similar to general characteristics in the population. The parameters of leukocyte, neutrophil-to-lymphocyte, and platelet-to-lymphocyte counts could be a valuable predictive parameters of mortality outcomes.

Duration of Tumor-infiltrating Lymphocytes Assessment with Significant Overall Survival Prognostic Value in Locally Advanced Breast Cancer

Background Tumor microenvironment, represented by tumor-infiltrating lymphocytes, was dynamically evolving throughout the time. Thus, in the interpretation of TIL as a prognostic factor overall survival of breast cancer, it is important to note the duration of the TIL examination until neoadjuvant chemotherapy is performed. Aim To determine whether the assessment of TIL at a certain duration still has value as a prognostic factor for the overall survival of breast cancer and its cut off point. Methods This was a retrospective cohort study that included subjects with locally advanced breast cancer in Sanglah General Hospital, registered in Bali’s Cancer Registry. The study has been approved by the institutional review board of Udayana University, Denpasar, Bali. Data collected were age, breast cancer subtype, value of TIL, time of NAC start, and duration of survival. Missing data were obtained from electronic medical records. TIL is then grouped into groups with low TIL (negative and +1) and high TIL (+2 and +3). Data analysis were done with Statistical Package for the Social Sciences 25.0. Results As many as 150 subjects with locally advanced breast cancer who survived and died in 2011-2020 were analyzed. The mean age of subjects in this study was 48.7 (SD 9.3) years with a median survival of 47 months. The mean duration of the TIL asessment to NAC was 46.3 days (SD 24.5). The duration cut off point of TIL assessment to NAC that is valuable as breast cancer’s overall prognostic value was 31 days (AUC 0.716, Sensitivity 64.1%, Specificity 35.5%). In subjects with TIL examined for less than 31 days, it was found that TIL could significantly prognosticated the overall survival of breast cancer (p = 0.005). High TIL was associated with better overall survival and low TIL is associated with poor overall survival. Discussion Tumor immune microenvironment played an important role in tumor progression and supression.  High levels of TIL has been generally accepted as an indicator for a more robust anti-tumor immune response, thus yielding favorable outcome. Timing of TIL analysis was important to determine as microenvironment dynamically progressing. In this study, we proved that timing matters and only short-term duration of TIL assessment to NAC meaningful as a prognostic value for breast cancer’s overall survival. Conclusion The duration of TIL to NAC assessment was important in determine the meaningful of TIL value in the prognostication overall survival of locally advanced breast cancer. The short-term TIL assessment duration (<31 days) predicted well, but not in the long term assessment duration. In the future, it is hoped that clinicians will be more critical in the interpretation of TIL, especially the duration of TIL assessment before NAC.

Determination of Significant Pretreatment Factors that Predict Survival in Indonesian Subjects with Breast Cancer

BACKGROUND: The determination of the pre-treatment’s survival predictive factors is very important as a basis for clinicians to educate and determine appropriate management for patients. AIM: This study aimed to determine the pre-treatment risk factors that predict survival in Indonesian subjects with breast cancer. METHODS: This was a cohort retrospective study conducted on breast cancer subjects visiting Sanglah General Hospital from 2016 to 2020. Data were collected from Indonesian Cancer Registry medical records such as age, tumor size, lymph nodes, metastasis, Karnofsky score, serum CA15-3 level, hormonal receptor status (ER/PR), HER2, Ki-67, LVI, tumor-infiltrating lymphocytes, cell type, histological grade, and survival status until December 2020. Data were tabulated and analyzed statistically using SPSS 25.0. RESULTS: The median survival of breast cancer in this study was 47 months (SD 4.851). Majority of breast cancer subjects with mortality outcome were those who had Karnofsky score less than 70, tumor size ≥5 cm with infiltration, presence of contralateral lymph node, with metastasis, serum CA15-3 level >25 IU/mL, negative hormonal receptor, negative HER2 receptor, Ki67 higher than 14, negative lymphovascular invasion, negative tumor-infiltrating lymphocytes, and histological Grade 3. Age and pathological type were not significantly differed the breast cancer outcome. CONCLUSION: There were significant effects of tumor size, KGB status, metastasis, serum CA15-3 levels, hormone receptor, HER2 receptor, Karnofsky score, lymphovascular invasion, tumor-infiltrating lymphocytes, and histological grade on breast cancer subjects’ survival.

S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis

BACKGROUND:

The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury.

AIM:

This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies.

METHODS:

We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark).

RESULTS:

The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively).

CONCLUSION:

S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.