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Abu-Abeid A, Shoham G, Keidar A. Conversion of One Anastomosis Gastric Bypass to Single Anastomosis Duodeno-Ileal Bypass with Sleeve Gastrectomy. Obes Surg 2024:10.1007/s11695-024-07241-1. [PMID: 38643296 DOI: 10.1007/s11695-024-07241-1] [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: 02/02/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Adam Abu-Abeid
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel Aviv, Israel.
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gon Shoham
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel Aviv, Israel
| | - Andrei Keidar
- Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6, Weizman St., 6423906, Tel Aviv, Israel
- Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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da Costa KM, Stratulat I, Saxena AK. Reasons for conversions in thoracoscopic repairs of neonatal congenital diaphragmatic hernias: a systematic review. Surg Endosc 2024:10.1007/s00464-024-10831-w. [PMID: 38619557 DOI: 10.1007/s00464-024-10831-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/25/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE This systematic review focused on reasons for conversions in neonates undergoing thoracoscopic congenital diaphragmatic hernia (CDH) repair. METHODS Systematic search of Medline/Pubmed and Embase was performed for English, Spanish and Portuguese reports, according to PRISMA guidelines. RESULTS Of the 153 articles identified (2003-2023), 28 met the inclusion criteria and offered 698 neonates for analysis. Mean birth weight and gestational age were 3109 g and 38.3 weeks, respectively, and neonates were operated at a mean age of 6.12 days. There were 278 males (61.50%; 278/452) and 174 females (38.50%; 174/452). The reasons for the 137 conversions (19.63%) were: (a) defect size (n = 22), (b) need for patch (n = 21); (c) difficulty in reducing organs (n = 14), (d) ventilation issues (n = 10), (e) bleeding, organ injury, cardiovascular instability (n = 3 each), (f) bowel ischemia and defect position (n = 2 each), hepatopulmonary fusion (n = 1), and (g) reason was not specified for n = 56 neonates (40.8%). The repair was primary in 322 neonates (63.1%; 322/510) and patch was used in 188 neonates (36.86%; 188/510). There were 80 recurrences (12.16%; 80/658) and 14 deaths (2.48%; 14/565). Mean LOS and follow-up were 20.17 days and 19.28 months, respectively. CONCLUSIONS Neonatal thoracoscopic repair for CDH is associated with conversion in 20% of cases. Based on available data, defect size and patch repairs have been identified as the predominant reasons, followed by technical difficulties to reduce the herniated organs and ventilation related issues. However, data specifically relating to conversion is poorly documented in a high number of reports (40%). Accurate data reporting in future will be important to better estimate and quantify reasons for conversions in neonatal thoracoscopy for CDH.
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Affiliation(s)
- Karina Miura da Costa
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
- Department of Health Sciences, Cesumar University (Unicesumar), Maringá, Paraná, Brazil
| | - Iulia Stratulat
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK
| | - Amulya Kumar Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, London, UK.
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Zhou B, Zhao Y, Wu X. Differences of individual gray matter networks between MCI patients who converted to AD within 3 Years and nonconverters. Heliyon 2024; 10:e28874. [PMID: 38623255 PMCID: PMC11016615 DOI: 10.1016/j.heliyon.2024.e28874] [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: 11/07/2023] [Revised: 03/24/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
Objective Here we aimed to explore the differences in individual gray matter (GM) networks at baseline in mild cognitive impairment patients who converted to Alzheimer's disease (AD) within 3 years (MCI-C) and nonconverters (MCI-NC). Materials and methods Data from 461 MCI patients (180 MCI-C and 281 MCI-NC) were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI). For each subject, a GM network was constructed using 3D-T1 imaging and the Kullback-Leibler divergence method. Gradient and topological analyses of individual GM networks were performed, and partial correlations were calculated to evaluate relationships among network properties, cognitive function, and apolipoprotein E (APOE) €4 alleles. Subsequently, a support vector machine (SVM) model was constructed to discriminate the MCI-C and MCI-NC patients at baseline. Results The gradient analysis revealed that the principal gradient score distribution was more compressed in the MCI-C group than in the MCI-NC group, with scores for the left lingual gyrus, right fusiform gyrus and left middle temporal gyrus being increased in the MCI-C group (p < 0.05, FDR corrected). The topological analysis showed significant differences in nodal efficiency in four nodes between the two groups. Furthermore, the regional gradient scores or nodal efficiency were found to be significantly related to the neuropsychological test scores, and the left middle temporal gyrus gradient scores were positively associated with the number of APOE €4 alleles (r = 0.192, p = 0.002). Ultimately, the SVM model achieved a balanced accuracy of 79.4% in classifying MCI-C and MCI-NC patients (p < 0.001). Conclusion The whole-brain GM network hierarchy in the MCI-C group was more compressed than that in the MCI-NC group, suggesting more serious cognitive impairments in the MCI-C group. The left middle temporal gyrus gradient scores were related to both cognitive function and APOE €4 alleles, thus serving as potential biomarkers distinguishing MCI-C from MCI-NC at baseline.
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Affiliation(s)
- Baiwan Zhou
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yueqi Zhao
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojia Wu
- Department of Radiology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Violante T, Ferrari D, Mathis KL, D'Angelo ALD, Dozois EJ, Merchea A, Larson DW. Robotic-assisted surgery conversion: the sooner, the better? Insights from a Single-Center Study. J Gastrointest Surg 2024:S1091-255X(24)00402-5. [PMID: 38583579 DOI: 10.1016/j.gassur.2024.04.003] [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: 02/20/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Tommaso Violante
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA; Division of Colon & Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA; School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Davide Ferrari
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA; Division of Colon & Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA; School of General Surgery, Alma Mater Studiorum University of Bologna, Bologna, Italy; General Surgery Residency Program, University of Milan, Milan, Italy
| | - Kellie L Mathis
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Eric J Dozois
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Amit Merchea
- Division of Colon & Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - David W Larson
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA.
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Pletch A, Lidor A. GERD after Bariatric Surgery: A Review of the Underlying Causes and Recommendations for Management. Curr Gastroenterol Rep 2024; 26:99-106. [PMID: 38353898 DOI: 10.1007/s11894-024-00919-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE OF REVIEW GERD after bariatric surgery is an ongoing concern for bariatric surgeons and their patients. This paper reviews the association of persistent or de novo GERD after multiple types of bariatric surgery, and focuses on the work up and management of GERD after SG. RECENT FINDINGS Two recent large, multicenter randomized clinical trials have shown stronger associations between SG and GERD compared to RYGB. A large group of internationally recognized bariatric surgeons collaborated on 72 consensus statements to help guide the bariatric community on the subject of redo surgeries after SG, including as it pertains to GERD. We present an algorithm that consolidates the best-practices recommendations of the work-up and management of GERD after sleeve gastrectomy, and mention areas of persistent controversy where future research is warranted.
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Affiliation(s)
- Alison Pletch
- Department of Surgery, University at Buffalo, 100 High Street, Buffalo, NY, D35014203, USA.
| | - Anne Lidor
- Division of Minimally Invasive Surgery, Department of Surgery, University of Wisconsin, School of Medicine and Public Health, 600 Highland Avenue, Madison, WI, 53726, USA
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Ferrari D, Violante T, Bhatt H, Gomaa IA, D'Angelo ALD, Mathis KL, Larson DW. Effect of previous abdominal surgery on robotic-assisted rectal cancer surgery. J Gastrointest Surg 2024; 28:513-518. [PMID: 38583904 DOI: 10.1016/j.gassur.2024.01.011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/04/2024] [Accepted: 01/13/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The effect of previous abdominal surgery (PAS) in laparoscopic surgery is well known and significantly adds to longer hospital length of stay (LOS), postoperative ileus, and inadvertent enterotomies. However, little evidence exists in patients with PAS undergoing robotic-assisted (RA) rectal surgery. METHODS All patients undergoing RA surgery for rectal cancer were reviewed. Patients with PAS were divided into minor and major PAS groups, defined as surgery involving >1 quadrant. The primary outcome was the risk of conversion to open surgery. RESULTS A total of 750 patients were included, 531 in the no-PAS (NPAS) group, 31 in the major PAS group, and 188 in the minor PAS group. Patients in the major PAS group had significantly longer hospital LOS (P < .001) and lower adherence to enhanced recovery pathways (ERPs; P = .004). The conversion rates to open surgery were similar: 3.4% in the NPAS group, 5.9% in the minor PAS group, and 9.7% in the major PAS group (P = .113). Estimated blood loss (EBL; P = .961), operative times (OTs; P = .062), complication rates (P = .162), 30-day readmission (P = .691), and 30-day mortality (P = .494) were similar. Of note, 53 patients underwent lysis of adhesions (LOA). On multivariate analysis, EBL >500 mL and LOA significantly influenced conversion to open surgery. EBL >500 mL, age >65 years, conversion to open surgery, and prolonged OT were risk factors for prolonged LOS, whereas adherence to ERPs was a protector. CONCLUSION PAS did not seem to affect the outcomes in RA rectal surgery. Given this finding, the robotic approach may ultimately provide patients with PAS with similar risk to patients without PAS.
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Affiliation(s)
- Davide Ferrari
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States; General Surgery Residency Program, University of Milan, Milan, Italy
| | - Tommaso Violante
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States; Surgery of the Alimentary Tract, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Himani Bhatt
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Ibrahim A Gomaa
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Anne-Lise D D'Angelo
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Kellie L Mathis
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States
| | - David W Larson
- Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States.
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Dumortier J, Boillot O. Conversion from twice-daily everolimus to once-daily sirolimus in long-term stable liver transplant recipients. Transpl Immunol 2024; 83:102014. [PMID: 38395088 DOI: 10.1016/j.trim.2024.102014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND After organ transplantation, strategies for simplifying the therapeutic regimen may improve adherence and prevent acute organ rejection and/or late graft loss. The present study aimed to evaluate the safety and efficacy of conversion from everolimus (EVR) twice daily to sirolimus (SIR) once daily in a large cohort of liver transplantation (LT) patients. METHODS We included 108 LT patients with at least 12 months of post-transplant follow-up and no rejection episodes in the last year. Conversion was based on a 1:1 ratio (but eventually adapted to available formulations of SIR). RESULTS The median age at the time of conversion was 68.9 years (range: 26.1-83.6); 75.0% were men. The main indications for mTOR inhibitor use were renal failure (38.9%) and/or a history of malignancy (37.0%). Median conversion time after LT was 14.8 years (range: 2.3-31.5). The median dose of EVR and SIR (initially) was 1.50 mg/day (range: 0.5-4.5). The mean follow-up after conversion was 15.8±4.4 months. Median serum EVR/SIR trough levels before/after conversion were 3.85 ng/mL vs. 6.32 ng/mL (p < 0.05), i.e. a 1:1.64 ratio. At the end of follow-up after conversion, the median dose of SIR was 1.25 mg/day (range: 0.5-3.5), and the mean serum SIR trough level was 5.23 ng/mL; 9 patients (8.3%) had returned to EVR, because of side effects (mainly digestive), that resolved thereafter. No biopsy-proven acute rejection episode was observed. Finally, 87.1% of patients considered the conversion beneficial and the cost was reduced by 50.3%. CONCLUSION The results of our study indicate that conversion from once-daily EVR to once-daily SIR in stable LT patients is safe, but needs dose adaptations and careful monitoring.
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Affiliation(s)
- Jérôme Dumortier
- Department of Digestive Diseases, Edouard Herriot Hospital, and University of Lyon 1 Claude Bernard, Lyon, France.
| | - Olivier Boillot
- Department of Digestive Diseases, Edouard Herriot Hospital, and University of Lyon 1 Claude Bernard, Lyon, France
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Tang J, Chen Q, Fu Z, Liang Y, Xu G, Zhou H, He B. Interaction between Aβ and tau on reversion and conversion in mild cognitive impairment patients: After 2-year follow-up. Heliyon 2024; 10:e26839. [PMID: 38463796 PMCID: PMC10923662 DOI: 10.1016/j.heliyon.2024.e26839] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Background The role of amyloid-β (Aβ) and tau in reversion and conversion in patients with mild cognitive impairment (MCI) remains unclear. This study aimed to investigate the influence of cerebrospinal fluid (CSF) Aβ and tau on reversion and conversion and the temporal sequence of their pathogenicity in MCI patients. Methods 179 MCI patients were recruited from the Alzheimer's Disease Neuroimaging Initiative database and classified into two groups based on cognitive changes after follow-up: reversal group (MCI to cognitively normal) and conversion group (MCI to Alzheimer's disease). CSF biomarkers and cognitive function were measured at baseline and 2-year follow-up. Partial correlation was used to analyze the association between CSF biomarkers and cognitive function, and multivariable logistic regression to identify independent risk factors for cognitive changes at baseline and 2-year follow-up. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive ability of these risk factors for cognitive changes. Results The differences in cognitive function and CSF biomarkers between the two groups remained consistent with baseline after 2-year follow-up. After controlling for confounding variables, there was still a correlation between CSF biomarkers and cognitive function at baseline and 2-year follow-up. Multivariable regression analysis found that at baseline, only Aβ level was independently associated with cognitive changes, while Aβ and tau were both predictive factors after 2-year follow-up. ROC curve analysis revealed that the combination of Aβ and tau [area under the curve (AUC) 0.91, sensitivity 84%, specificity 86%] in predicting cognitive changes after 2-year follow-up had better efficacy than baseline Aβ alone (AUC 0.81). Conclusion Aβ may precede Tau in causing cognitive changes, and the interaction between the two mediates cognitive changes in patients. This study provides new clinical evidence to support the view that Aβ pathology precedes tau pathology, which together contribute to the changes in cognitive function.
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Affiliation(s)
- Jinzhi Tang
- Neurological Function Examination Room, The First Affiliated Hospital of Jinan University, Guangzhou, PR China
| | - Qiuping Chen
- Neurological Function Examination Room, The First Affiliated Hospital of Jinan University, Guangzhou, PR China
| | - Zhenfa Fu
- Department of Rehabilitation, Guangzhou Panyu Health Management Center (Guangzhou Panyu Rehabilitation Hospital), Guangzhou, PR China
| | - Yuqun Liang
- Department of Rehabilitation, Guangzhou Panyu Health Management Center (Guangzhou Panyu Rehabilitation Hospital), Guangzhou, PR China
| | - Guohua Xu
- Department of Rehabilitation, Guangzhou Panyu Health Management Center (Guangzhou Panyu Rehabilitation Hospital), Guangzhou, PR China
| | - Huan Zhou
- Neurological Function Examination Room, The First Affiliated Hospital of Jinan University, Guangzhou, PR China
| | - Bingjie He
- Department of Rehabilitation, Guangzhou Panyu Health Management Center (Guangzhou Panyu Rehabilitation Hospital), Guangzhou, PR China
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Ramamoorthy K, Dhanraj R, Vijayakumar N, Ma Y, Al Obaid S, Narayanan M. Vegetable and fruit wastes: Valuable source for organic fertilizer for effective growth of short-term crops: Solanum lycopersicum and Capsicum annum. Environ Res 2024; 251:118727. [PMID: 38490629 DOI: 10.1016/j.envres.2024.118727] [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] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/17/2024]
Abstract
Agriculture plays a vital role in the food security and economies of Asian countries. Annually, numerous metric tons of vegetable and fruit wastes are disposed of. This research aimed to convert the food wastes encompassing the vegetable and fruit wastes into solid and liquid organic fertilizer and to evaluate their influence on the growth (germination, phytochemicals, and biomolecules) of Solanum lycopersicum and Capsicum annum. Solanum lycopersicum, known as tomato, and Capsicum annum, known as bell pepper or chili pepper, are globally significant crops valued for their medicinal properties and economic importance. The pot experiment was performed with organic fertilizers (solid and liquid organic fertilizer) and compared with the influence of chemical fertilizer and control soil without fertilizers. Interestingly, the liquid organic fertilizer effectively enhanced the biometric profile and chlorophyll content of S. lycopersicum and C. annum Viz., 1.23 mg g-1 and 0.89 mg g-1, respectively. The results of a 30-days pot experiment with various fertilizer treatments showed significant influence of liquid organic fertilizer on the fresh and dry weight biomass of both S. lycopersicum and C. annum. Subsequently, the solid organic fertilizer showed considerable influence on test crops, and the influence of these organic fertilizers was more significant than the chemical fertilizer on crop growth in 30-days experiment. These results suggest that the sustainable approach can effectively convert vegetables and fruit waste into valuable organic fertilizer enriched with plant growth supporting essential nutritional elements.
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Affiliation(s)
- Kavitha Ramamoorthy
- Department of Biotechnology, Periyar University, Salem - 636 011, Tamil Nadu, India
| | - Rajesh Dhanraj
- Department of Biotechnology, Periyar University Centre for Post Graduate and Research Studies, Dharmapuri, 635 205, Tamil Nadu, India
| | - Natesan Vijayakumar
- Department of Biochemistry and Biotechnology, Faculty of Science, Annamalai University, Annamalainagar-608 002, Tamil Nadu, India
| | - Ying Ma
- College of Resources and Environment, Southwest University, Chongqing, 400716, China
| | - Sami Al Obaid
- Department of Botany and Microbiology, College of Science, King Saud University, PO Box -2455, Riyadh, 11451, Saudi Arabia
| | - Mathiyazhagan Narayanan
- Department of Research and Innovations, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Science, Chennai, 602 105, Tamil Nadu, India.
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Yoo GY, Yoon SK, Moon MH, Moon SW, Hwang W, Kim KS. Development of a Risk Scoring Model to Predict Unexpected Conversion to Thoracotomy during Video-Assisted Thoracoscopic Surgery for Lung Cancer. J Chest Surg 2024:jcs.23.140. [PMID: 38472121 DOI: 10.5090/jcs.23.140] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/17/2023] [Accepted: 01/15/2024] [Indexed: 03/14/2024] Open
Abstract
Background Unexpected conversion to thoracotomy during planned video-assisted thoracoscopic surgery (VATS) can lead to poor outcomes and comparatively high morbidity. This study was conducted to assess preoperative risk factors associated with unexpected thoracotomy conversion and to develop a risk scoring model for preoperative use, aimed at identifying patients with an elevated risk of conversion. Methods A retrospective analysis was conducted of 1,506 patients who underwent surgical resection for non-small cell lung cancer. To evaluate the risk factors, univariate analysis and logistic regression were performed. A risk scoring model was established to predict unexpected thoracotomy conversion during VATS of the lung, based on preoperative factors. To validate the model, an additional cohort of 878 patients was analyzed. Results Among the potentially significant clinical variables, male sex, previous ipsilateral lung surgery, preoperative detection of calcified lymph nodes, and clinical T stage were identified as independent risk factors for unplanned conversion to thoracotomy. A 6-point risk scoring model was developed to predict conversion based on the assessed risk, with patients categorized into 4 groups. The results indicated an area under the receiver operating characteristic curve of 0.747, with a sensitivity of 80.5%, specificity of 56.4%, positive predictive value of 1.8%, and negative predictive value of 91.0%. When applied to the validation cohort, the model exhibited good predictive accuracy. Conclusion We successfully developed and validated a risk scoring model for preoperative use that can predict the likelihood of unplanned conversion to thoracotomy during VATS of the lung.
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Affiliation(s)
- Ga Young Yoo
- Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Keun Yoon
- Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mi Hyoung Moon
- Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seok Whan Moon
- Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wonjung Hwang
- Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Departments of 1Thoracic and Cardiovascular Surgery and 2Anesthesiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Bezlepkina NP, Bocharnikova EN, Tchaikovskaya ON, Mayer GV, Solomonov VI, Makarova AS, Spirina AV, Chaikovsky SA. The Conversion and Degradation of Sulphaguanidine under UV and Electron Beam Irradiation Using Fluorescence. J Fluoresc 2024:10.1007/s10895-024-03640-w. [PMID: 38460095 DOI: 10.1007/s10895-024-03640-w] [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: 01/04/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
The work presents a spectral-luminescent study of the sulfaguanidine transformation in water under a pulsed e-beam and UV irradiation of an UVb-04 bactericidal mercury lamp (from 180 to 275 nm), KrCl (222 nm), XeBr (282 nm) and XeCl (308 nm) excilamps. Fluorescent decay curves have been used in our analysis of the sulfaguanidine decomposition. The conversion of antibiotic under e-beam irradiation for up to 1 min was more than 80%, compared with UV radiation: UVb-04-26%, XeBr - 20%. KrCl and XeCl - about 10%. At the end of 64 min of irradiation with UVb-04 and XeBr lamps, the conversion was 99%. During irradiation with these lamps, sulfaguanidine almost completely decomposed and passed into the final fluorescent photoproducts. After e-beam irradiated at the end of 13 min the decrease in sulfaguanidine was 93%. At the same time, the formation of sulfaguanidine transformation products was minimal compared to UV irradiation. The effect of UV irradiation and a powerful e-beam on the decomposition mechanisms of sulfaguanidine are significantly different, which is manifested in various changes in the absorption and fluorescence spectra.
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Affiliation(s)
- Nadezhda P Bezlepkina
- Departament of Physics, National Research Tomsk State University, Tomsk, 634050, Russia
| | - Elena N Bocharnikova
- Departament of Physics, National Research Tomsk State University, Tomsk, 634050, Russia
| | - Olga N Tchaikovskaya
- Departament of Physics, National Research Tomsk State University, Tomsk, 634050, Russia.
- The FSBIS Institute of Electrophysics, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, 620016, Russia.
| | - Georgy V Mayer
- Departament of Physics, National Research Tomsk State University, Tomsk, 634050, Russia
| | - Vladimir I Solomonov
- The FSBIS Institute of Electrophysics, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, 620016, Russia
| | - Anna S Makarova
- The FSBIS Institute of Electrophysics, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, 620016, Russia
| | - Alya V Spirina
- The FSBIS Institute of Electrophysics, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, 620016, Russia
| | - Stanislav A Chaikovsky
- The FSBIS Institute of Electrophysics, Ural Branch of the Russian Academy of Sciences, Ekaterinburg, 620016, Russia
- The Lebedev Physical Institute of the Russian Academy of Sciences, Moscow, 19991, Russia
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Goto K, Watanabe J, Nagasaki T, Uemura M, Ozawa H, Kurose Y, Akagi T, Ichikawa N, Iijima H, Inomata M, Taketomi A, Naitoh T. Impact of the endoscopic surgical skill qualification system on conversion to laparotomy after low anterior resection for rectal cancer in Japan (a secondary analysis of the EnSSURE study). Surg Endosc 2024:10.1007/s00464-024-10740-y. [PMID: 38459211 DOI: 10.1007/s00464-024-10740-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/28/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND AND AIMS Conversion to laparotomy is among the serious intraoperative complications and carries an increased risk of postoperative complications. In this cohort study, we investigated whether or not the Endoscopic Surgical Skill Qualification System (ESSQS) affects the conversion rate among patients undergoing laparoscopic surgery for rectal cancer. METHODS We performed a retrospective secondary analysis of data collected from patients undergoing laparoscopic surgery for cStage II and III rectal cancer from 2014 to 2016 across 56 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery. Data from the original EnSSURE study were analyzed to investigate risk factors for conversion to laparotomy by performing univariate and multivariate analyses based on the reason for conversion. RESULTS Data were collected for 3,168 cases, including 65 (2.1%) involving conversion to laparotomy. Indicated conversion accounted for 27 cases (0.9%), while technical conversion accounted for 35 cases (1.1%). The multivariate analysis identified the following independent risk factors for indicated conversion to laparotomy: tumor diameter [mm] (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01-1.05, p = 0.0002), combined resection of adjacent organs [+/-] (OR 7.92, 95% CI 3.14-19.97, p < 0.0001), and surgical participation of an ESSQS-certified physician [-/+] (OR 4.46, 95% CI 2.01-9.90, p = 0.0002). The multivariate analysis identified the following risk factors for technical conversion to laparotomy: registered case number of institution (OR 0.99, 95% CI 0.99-1.00, p = 0.0029), institution type [non-university/university hospital] (OR 3.52, 95% CI 1.54-8.04, p = 0.0028), combined resection of adjacent organs [+/-] (OR 5.96, 95% CI 2.15-16.53, p = 0.0006), and surgical participation of an ESSQS-certified physician [-/+] (OR 6.26, 95% CI 3.01-13.05, p < 0.0001). CONCLUSIONS Participation of ESSQS-certified physicians may reduce the risk of both indicated and technical conversion. Referral to specialized institutions, such as high-volume centers and university hospitals, especially for patients exhibiting relevant background risk factors, may reduce the risk of conversion to laparotomy and lead to better outcomes for patients. TRIAL REGISTRATION This study was registered with the Japanese Clinical Trials Registry as UMIN000040645.
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Affiliation(s)
- Koki Goto
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Toshiya Nagasaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Mamoru Uemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Heita Ozawa
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Yohei Kurose
- Department of Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan.
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Iijima
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University, Oita, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
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Liang X, Li C, Yuan W, Ji M, Zhang J, Yan M, Lu Q, Gou J, Yin T, He H, Tang X, Zhang Y. Activate the endogenous Cu 2+ switch for Zn(DDC) 2 liposomes conversion: Providing a safer and less toxic alternative in cancer therapy. Int J Pharm 2024; 652:123800. [PMID: 38218507 DOI: 10.1016/j.ijpharm.2024.123800] [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: 08/26/2023] [Revised: 12/31/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
The ancient anti-alcohol drug disulfiram (DSF) has gained widespread attention for its highly effective anti-tumor effects in cancer treatment. Our previous studies have developed liposome of Cu (DDC)2 to overcome the limitations, like the poor water solubility. However, Cu (DDC)2 liposomes still have shown difficulties in severe hemolytic reactions at high doses and systemic toxicity, which have limited their clinical use. Therefore, this study aims to exploratively investigate the feasibility of using DSF or DDC in combination also can chelate Zn2+ to form zinc diethyldithiocarbamate (Zn (DDC)2). Furthermore, this study prepared stable and homogeneous Zn (DDC)2 liposomes, which were able to be released in the tumor microenvironment (TME). The released Zn (DDC)2 was converted to Cu (DDC)2 with the help of endogenous Cu2+-switch enriched in the TME, which has a higher stability constant compared with Zn (DDC)2. In other words, the Cu2+-switch is activated at the tumor site, completing the conversion of the less cytotoxic Zn (DDC)2 to the more cytotoxic Cu (DDC)2 for effective tumor therapy so that the Zn (DDC)2 liposomes in vivo achieved the comparable therapeutic efficacy and provided a safer alternative to Cu (DDC)2 liposomes in cancer therapy.
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Affiliation(s)
- Xinxin Liang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Chunxue Li
- Beijing Sun-Novo Pharmaceutical Research Co.Ltd 102200, NO.79 Shuangying West Road, Changping District, Beijing, China
| | - Wei Yuan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Muse Ji
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Jie Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Mingjiao Yan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Qianru Lu
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Jingxin Gou
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Tian Yin
- School of Functional Food and Wine, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Haibing He
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Xing Tang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China
| | - Yu Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning, China.
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Stancu AM, Alexandrescu D, Badiu C. Effects of block-replace regimen in patients with autoimmune hypothyroidism converted to Graves' disease. Hormones (Athens) 2024; 23:107-111. [PMID: 37831339 DOI: 10.1007/s42000-023-00496-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE We present two cases of autoimmune hypothyroidism converted to Graves' disease (GD) and their medical management. METHODS We tested thyroid function and thyroid antibodies and performed an ophthalmologic examination and neck ultrasound in two patients with autoimmune hypothyroidism converted to GD during a follow-up of several years. CASE REPORTS The first case is a 33 year-old woman with hypothyroidism due to Hashimoto's thyroiditis (HT). She developed signs and symptoms of hyperthyroidism after 7 years of treatment with the same dose of levothyroxine (LT4). Even when LT4 therapy was discontinued, she remained thyrotoxic, with mild Graves' ophthalmopathy (GO) and very high thyroid-stimulating hormone receptor antibodies (TRAb > 40 IU/L, reference range: <1.75 IU/L). Antithyroid medication was started on a titration regimen, without achievement of euthyroidism. She was switched to a block and replace regimen, using 20 mg of methimazole (MMI) and 75 mcg of LT4 daily, with normalization of thyroid hormones and improvement of GO without steroids. The second case is a 57 year-old man with a 2-year positive medical history of HT and 6 months of LT4 treatment. He developed hyperthyroidism and moderate-severe GO. Despite stopping LT4 and initiating antithyroid medication in a titration regimen, he did not achieve euthyroidism and had active GO. Pulse glucocorticoid therapy and switching to a block-replace regimen was required to achieve euthyroidism and reduce ocular proptosis and diplopia. CONCLUSION Spontaneous autoimmune conversion of hypothyroidism to hyperthyroidism can occur at any time: it is important to promptly identify these cases so as to manage them effectively.
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Affiliation(s)
- Ana-Maria Stancu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania.
| | - Daniela Alexandrescu
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania
| | - Corin Badiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- "C.I.Parhon" National Institute of Endocrinology, Bd. Aviatorilor, no. 34-36, sector 1, 011863, Bucharest, Romania
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Carandina S, Soprani A, Sista F, De Palma M, Murcia S, Sartori A, Silvia F, Nedelcu A, Zulian V, Nedelcu M. Conversion of one-anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for gastroesophageal reflux disease (GERD): who is more at risk? A multicenter study. Surg Endosc 2024; 38:1163-1169. [PMID: 38082009 DOI: 10.1007/s00464-023-10611-y] [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: 08/27/2023] [Accepted: 11/26/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Although gastroesophageal reflux disease (GERD) affects 0.6% to 10% of patients operated on for one-anastomosis gastric bypass (OAGB), only about 1% require surgery to convert to Roux-en-Y gastric bypass (RYGB) [3-5]. The aim of the present study was to analyze the characteristics of OAGB patients converted to RYGB for GERD not responding to medical treatment. METHODS This retrospective multicenter study included patients who underwent conversion from OAGB to RYGB for severe GERD. The conversion was performed with resection of the previous gastro-jejunal anastomosis and the use of the afferent loop as a new biliary loop. RESULTS A total of 126 patients were included in the study. Of these patients, 66 (52.6%) had a past medical history of bariatric restrictive surgery (gastric banding, sleeve gastrectomy). A hiatal hernia (HH) was present in 56 patients (44.7%). The association between previous restrictive surgery and HH was recorded in 33 (26.2%) patients. Three-dimensional gastric computed tomography showed an average gastric pouch volume of 242.4 ± 55.1 cm3. Conversion to RYGB was performed on average 60 ± 35.6 months after OAGB. Seven patients (5.5%) experienced an early postoperative complication (4 patients grade IIIb and 3 grade IIb), and 3 (2.4%) a late complication. Patients showed further weight loss after RYGB conversion and an average of 24.8 ± 21.7 months after surgery, with a mean % of total weight loss (%TWL) of 6.9 ± 13.6 kg. From a clinical point of view, the problem of GERD was definitively solved in more than 90% of patients. CONCLUSIONS Situations that weaken the esogastric junction appear to be highly frequent in patients operated on for OAGB and converted to RYGB for severe reflux. Similarly, the correct creation of the gastric pouch could play an important role in reducing the risk of conversion to RYGB for GERD.
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Affiliation(s)
- Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France.
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy.
| | - Antoine Soprani
- Department of Digestive and Bariatric Surgery, Clinique Geoffroy-Saint Hilaire, Générale de Santé (GDS), 75005, Paris, France
| | - Federico Sista
- Department of Surgery, Ospedale Civile San Salvatore L'Aquila, UOC di Chirurgia Epato-Bilio- Pancreatica, L'Aquila, Italy
| | - Massimiliano De Palma
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy
| | - Sebastien Murcia
- Department of Digestive and Bariatric Surgery, Clinique de Villeneuve, Villeneuve Sur Lot, France
| | - Andrea Sartori
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy
| | - Ferro Silvia
- Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France
| | - Viola Zulian
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France
| | - Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France
- ELSAN, Clinique Bouchard, Centre Chirurgical de l'Obésité (CCO), 13006, Marseille, France
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16
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Sheng Y, Zheng J, Tao L, Shen Z, Liang X. Risk factor analysis of conversion in laparoscopic liver resection for intrahepatic cholangiocarcinoma. Surg Endosc 2024; 38:1191-1199. [PMID: 38082010 DOI: 10.1007/s00464-023-10579-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/04/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND The risk factors of patients with intrahepatic cholangiocarcinoma (ICC) requiring conversion to open surgery have not been adequately studied. This study aimed to determine the risk factors and postoperative outcomes of conversion in patients with ICC. METHODS From May 2014 to September 2022, Unplanned conversions were compared with successful LLRs. RESULTS 153 patients with ICC initially underwent LLR, of which 41 (26.8%) required conversion to open surgery. Multivariate analysis for those factors that were statistically significant or confirmed by clinical studies, tumor proximity to the major vessels (OR 6.643, P < 0.001), and previous upper abdominal surgery (OR 3.140, P = 0.040) were independent predictors of unplanned conversions. Compared to successful LLRs, unplanned conversions showed longer operative times (300.0 vs. 225.0 min, P < 0.001), more blood loss (500.0 vs. 200.0 mL, P < 0.001), higher transfusion rates (46.3% vs. 11.6%, P < 0.001), longer length of stays (13.0 vs. 8.0 days, P < 0.001), and higher rates of major morbidity (39.0% vs. 11.6%, P < 0.001). However, there was no statistically significant difference in 30-day or 90-day mortality between the conversion group and the laparoscopic group. CONCLUSION Conversion during LLR should be anticipated in ICC patients with prior upper abdominal surgery or tumor proximity to major vessels as features.
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Affiliation(s)
- Yubin Sheng
- Department of General Surgery, The First People's Hospital of Jiashan County, No. 1218, South Sports Road, Jiashan, 314100, China
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Junhao Zheng
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Liye Tao
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Zefeng Shen
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China
| | - Xiao Liang
- Department of General Surgery, Zhejiang University, School of Medicine, Sir Run Run Shaw Hospital, 3 East Qingchun Road, Hangzhou, 310016, Zhejiang, China.
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Poursalehian M, Lotfi M, Mortazavi SMJ. Latent infections in conversion total hip arthroplasty following internal fixation of femoral neck fractures: a systematic review and meta-analysis of diagnostic methods. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05216-6. [PMID: 38367062 DOI: 10.1007/s00402-024-05216-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/29/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Accurate diagnosis of latent infections prior to conversion total hip arthroplasty (THA) following internal fixation of femoral neck fractures is crucial for successful surgical outcomes. This systematic review aimed to provide a comprehensive evaluation of the current literature regarding the diagnosis of latent infections before conversion THA. METHODS Systematic search of PubMed, EMBASE, and Cochrane (CENTRAL) databases was conducted, and the diagnostic accuracy of various markers and techniques was assessed. The quality of the included studies was evaluated using the QUADAS-2 instrument. RESULTS Five studies comprising 661 patients were included in the review. Pooled analysis using C-reactive protein (CRP) as a diagnostic marker resulted in a sensitivity and specificity of 72% and 76%, respectively, while using erythrocyte sedimentation rate (ESR) yielded a sensitivity and specificity of 75% and 78%, respectively. Fibrinogen and platelet count showed lower sensitivity and specificity compared to CRP and ESR. The best combined markers were CRP and serum platelet count, with a sensitivity of 76% and specificity of 86% based on one study. CONCLUSION Our review underscored the limitations and inconsistencies present in current diagnostic methods for latent infections in conversion surgery. Future research needs to focus on standardizing threshold values, exploring the potential of synovial fluid analysis, imaging techniques, and molecular methods, as well as developing tailored diagnostic algorithms. PROSPERO CRD42023394757.
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Affiliation(s)
- Mohammad Poursalehian
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Lotfi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Orthopedic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
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Ogugua PC, Su H, Wang E. Synergistic blending of biomass, sewage sludge, and coal for enhanced bioenergy production: Exploring residue combinations and optimizing thermal conversion parameters. J Environ Manage 2024; 352:120035. [PMID: 38244407 DOI: 10.1016/j.jenvman.2024.120035] [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] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/10/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
Creating renewable energy from lignocellulosic biomass is essential for a sustainable future. Due to their abundance and the possibility of producing cheap and clean energy, non-lignocellulosic wastes like sewage sludge from industrial and municipal wastes have drawn attention as a feasible alternative to fossil fuels. These abundant, cost-effective resources may help minimize the effects of climate change since they produce less pollution. Several drawbacks are associated with using sewage sludge in thermal conversion procedures. These issues encompass suboptimal energy yield, elevated ash levels in the final product, and subpar biomass quality. Using these scraps in conjunction with coal might enhance energy conversion processes. This study has revealed the necessity for further investigation into how various combinations of residues interact with each other, influencing synergistic effects and degradation processes. The study's underlying objective was to provide a centralized database on the synergistic effects of mixing biomass and sewage sludge for bioenergy production, coal and biomass, and coal and sewage sludge through thermochemical processes like combustion, pyrolysis, gasification, and hydrolysis with Aspen Plus. This study will assist in enhancing biofuels' output from sewage sludge, coal, and coal/biomass blends in thermal conversion by defining the operating parameters (temperature, heat, and residence duration) of pyrolysis and combustion, features, and chemical properties that may influence these processes.
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Affiliation(s)
- Paul Chinonso Ogugua
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Huihui Su
- School of China-UK Low Carbon College, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Enlu Wang
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China.
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Asbjornsson V, Johannsdottir G, Myer D, Runarsson TG, Heitmann LA, Oskarsdottir GN, Silverborn PM, Hansen HJ, Gudbjartsson T. A successful shift from thoracotomy to video-assisted thoracoscopic lobectomy for non-small cell lung cancer in a low-volume center. Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae018. [PMID: 38290794 PMCID: PMC10882427 DOI: 10.1093/icvts/ivae018] [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] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVES Although video-assisted thoracoscopic surgery (VATS) lobectomy has become the gold standard for pulmonary resections of non-small-cell lung cancer (NSCLC), lobectomy is still performed via thoracotomy in many European and North American centres. VATS lobectomy was implemented overnight from thoracotomy in our low-volume centre in early 2019, after 1 senior surgeon undertook observership VATS-training overseas, and immediately became the mainstay of surgical treatment for NSCLC in Iceland. We aimed to investigate our short-term outcomes of VATS lobectomy. METHODS This was a retrospective study on all pulmonary resections for NSCLC in Iceland 2019-2022, especially focusing on VATS lobectomies, all at cTNM stage I or II. Data were retrieved from hospital charts, including information on perioperative complications, mortality, length of stay and operation time. RESULTS Out of 204 pulmonary resections, mostly performed by a single senior cardiothoracic surgeon, 169 were lobectomies (82.9%) with 147 out of 169 (87.0%) being VATS lobectomies. Anterolateral thoracotomy was used in 34 cases (16.7%), including 22 lobectomies (64.7%), and 5 (3.4%) conversions from VATS lobectomy. The median postoperative stay for VATS lobectomy was 4 days and the average operating time decreased from 155 to 124 min between the first and last year of the study (P < 0.001). The rate of major and minor complications was 2.7% and 15.6% respectively. One year survival was 95.6% and all patients survived 30 days postoperatively. CONCLUSIONS The implementation of VATS lobectomy has been successful in our small geographically isolated centre, serving a population of 390 000. Although technically challenging, VATS lobectomy was implemented fast for most NSCLC cases, with short-term outcomes that are comparable to larger high-volume centres.
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Affiliation(s)
- Viktor Asbjornsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Daniel Myer
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | | | - Per Martin Silverborn
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Rigshospitalet University Hospital, Copenhagen, Denmark
| | - Tomas Gudbjartsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
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20
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Yan W, Zhang Y, Bi Y. Subnanometric Bismuth Clusters Confined in Pyrochlore-Bi 2 Sn 2 O 7 Enable Remarkable CO 2 Photoreduction. Angew Chem Int Ed Engl 2024; 63:e202316459. [PMID: 38018330 DOI: 10.1002/anie.202316459] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/31/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 11/30/2023]
Abstract
The development of highly efficient photocatalysts for conversion of carbon dioxide (CO2 ) with water (H2 O) into chemical fuels is of great importance for energy sustainability and carbon resource utilization. Herein, we demonstrated a facile hydrothermal method for in situ construction of subnanometric Bi metallic clusters in pyrochlore-Bi2 Sn2 O7 frameworks, leading to the remarkable improvements of photocatalytic performances for CO2 reduction into CO in the absence of sacrificial reagent. More specifically, an outstanding CO evolution activity of 114.1 μmol g-1 h-1 has been achieved, more than 20-fold improvement compared with the pristine Bi2 Sn2 O7 (5.7 μmol g-1 h-1 ). Detailed experiments together with in situ characterizations reveal that the spatially confined Bi clusters could significantly promote charge-separation/electron-enrichment and adsorption/activation of CO2 molecules, which provides highly efficient reaction channels to facilitate the generation of *COOH intermediate as well as the subsequent desorption of *CO towards CO formation. These demonstrations provide an important knowledge for precise design and fabrication of highly efficient photocatalysts for CO2 conversion into solar fuels.
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Affiliation(s)
- Wenkai Yan
- State Key Laboratory for Oxo Synthesis and Selective Oxidation, National Engineering Research Center for Fine Petrochemical Intermediates, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
| | - Yajun Zhang
- State Key Laboratory for Oxo Synthesis and Selective Oxidation, National Engineering Research Center for Fine Petrochemical Intermediates, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, P. R. China
| | - Yingpu Bi
- State Key Laboratory for Oxo Synthesis and Selective Oxidation, National Engineering Research Center for Fine Petrochemical Intermediates, Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences, Lanzhou, 730000, P. R. China
- University of Chinese Academy of Sciences, Beijing, 100049, P. R. China
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Roulet M, Phocas C, Becouarn G, Finel JB, Topart P. Long-term results of conversion of Roux-en-Y to biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis 2024:S1550-7289(24)00024-8. [PMID: 38342720 DOI: 10.1016/j.soard.2023.12.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/24/2023] [Accepted: 12/25/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Despite the fact Roux-en-Y gastric bypass (RYGB) is one of the most efficient bariatric procedures, postoperative weight regain still can be seen. OBJECTIVES To retrospectively assess the early outcomes and up to 10-year weight results of the conversion of RYGB to biliopancreatic diversion with duodenal switch (BPD-DS). SETTING French private hospital, 2-surgeon practice in a bariatric surgery center with an experience of >20 RYGB procedures. METHODS Analysis was conducted on patients who had a conversion of RYGB to BPD-DS performed since 2010 for a percentage of excess weight loss (%EWL) <50% with a small gastric pouch. RESULTS A total of 65 females and 9 males aged 46.8 ± 8.8 years had an RYGB procedure done 110.6 ± 38.8 months earlier for a body mass index of 47.4 ± 7.8 kg/m2. Conversion was always performed in 1 stage and laparoscopically for 93% of the patients. The 30-day complication rate was 25.7%, with 14.8% of patients undergoing reoperation. Maximum results were seen 2 years after conversion, outranging RYGB: %EWL of 78.3% ± 24% with percent total weight loss (%TWL) of 35.9% ± 11.9% and %EWL of 72% ± 24.1% with %TWL of 32.6% ± 11%, respectively. The 5-year weight of all the patients (85.7% follow-up) remained lower than the pre-conversion weight. Over time, 1 reversal and 4 revisions were required, and frequent stools and gastroesophageal reflux were the most frequent complaints. CONCLUSION Despite its complexity, conversion of RYGB to BPD-DS can be performed in 1 stage, although the use of an unconventional technique could not reduce the high complication rate. BPD-DS remains an efficient procedure after RYGB in selected patients, comparable to distalization of RYGB, which can be less risky.
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Affiliation(s)
- Maxime Roulet
- Société de chirurgie viscérale, clinique de l'Anjou, Angers, France
| | - Carine Phocas
- Société de chirurgie viscérale, clinique de l'Anjou, Angers, France
| | | | | | - Philippe Topart
- Société de chirurgie viscérale, clinique de l'Anjou, Angers, France.
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22
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Linakis MW, Van Landingham C, Gasparini A, Longnecker MP. Re-expressing coefficients from regression models for inclusion in a meta-analysis. BMC Med Res Methodol 2024; 24:6. [PMID: 38191310 PMCID: PMC10773134 DOI: 10.1186/s12874-023-02132-y] [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: 06/27/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024] Open
Abstract
Meta-analysis poses a challenge when original study results have been expressed in a non-uniform manner, such as when regression results from some original studies were based on a log-transformed key independent variable while in others no transformation was used. Methods of re-expressing regression coefficients to generate comparable results across studies regardless of data transformation have recently been developed. We examined the relative bias of three re-expression methods using simulations and 15 real data examples where the independent variable had a skewed distribution. Regression coefficients from models with log-transformed independent variables were re-expressed as though they were based on an untransformed variable. We compared the re-expressed coefficients to those from a model fit to the untransformed variable. In the simulated and real data, all three re-expression methods usually gave biased results, and the skewness of the independent variable predicted the amount of bias. How best to synthesize the results of the log-transformed and absolute exposure evidence streams remains an open question and may depend on the scientific discipline, scale of the outcome, and other considerations.
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Affiliation(s)
- Matthew W Linakis
- Ramboll U.S. Consulting, Raleigh, NC, 27612, USA, 3214 Charles B Root Wynd #130.
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23
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Pavy-Le Traon A, Foubert-Samier A, Fabbri M. An overview on pure autonomic failure. Rev Neurol (Paris) 2024; 180:94-100. [PMID: 38129276 DOI: 10.1016/j.neurol.2023.11.003] [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: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
Pure autonomic failure (PAF) is a neurodegenerative disease affecting the sympathetic component of the autonomic nervous system and presenting as orthostatic hypotension (OH). It is a rare, sporadic disease of adults. Although OH is the primary symptom, the autonomic dysfunction may be more generalised, leading to genitourinary and intestinal dysfunction and sweating disorders. Autonomic symptoms in PAF may be similar to those observed in other autonomic neuropathies that need to be ruled out. PAF belongs to the group of α synucleinopathies and is characterised by predominant peripheral deposition of α-synuclein in autonomic ganglia and nerves. However, in a significant number of cases, PAF may convert into another synucleinopathy with central nervous system involvement with varying prognosis: Parkinson's disease (PD), multiple system atrophy (MSA), or dementia with Lewy bodies (DLB). The clinical features, the main differential diagnoses, the risk factors for "phenoconversion" to another synucleinopathy as well as an overview of treatment will be discussed.
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Affiliation(s)
- A Pavy-Le Traon
- Neurology department, French reference center for Multiple System Atrophy, CHU de Toulouse, Toulouse, France; I2MC Institute-Inserm U1297, Toulouse, France
| | - A Foubert-Samier
- Bordeaux University, Inserm, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France; Neurodegenerative Diseases Neurology Department, CHU de Bordeaux, IMNc, CRMR AMS, Bordeaux, France; Bordeaux University, CNRS, IMN, UMR 5293, Bordeaux, France
| | - M Fabbri
- Neurology department, French reference center for Multiple System Atrophy, CHU de Toulouse, Toulouse, France; Department of Clinical Pharmacology and Neurosciences, Toulouse Parkinson Expert Centre, Toulouse NeuroToul Center of Excellence in Neurodegeneration (COEN), French NS-Park/F-CRIN Network, University of Toulouse 3, CHU of Toulouse, Inserm, Toulouse, France
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24
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Karimov Z, Kim SM, Turk Y, Dionigi G, Moscoso ES, Ozdemir M, Frattini F, Ozgul S, Makay O. Complication and conversion outcomes in transoral endoscopic thyroidectomy vestibular approach (TOETVA): a retrospective multicenter propensity score-matched cohort study. Updates Surg 2024; 76:227-238. [PMID: 38095833 DOI: 10.1007/s13304-023-01721-2] [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: 10/05/2023] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
Transoral endoscopic thyroidectomy with vestibular approach (TOETVA) is a scarless thyroid surgery used as an alternative to open conventional surgery. Our aim was to investigate possible risk factors for complications and conversion during TOETVA. The study was conducted internationally by centres from Turkiye, the Republic of Korea, Italy, and Peru. A total of 406 patients who underwent TOETVA and were ≥ 18 years of age were included in the study. Demographic, pre-, intra-, and postoperative data were collected and compared between the groups with/without complication/conversion to identify possible predictors of complication/conversion. Subsequently, patients with complication/conversion were matched by the hospital, age, sex, and American Society of Anesthesiologists classification score using a propensity score (PSM) of 1:3 to eliminate confounding differences. Results were reported for the un-matched and matched groups. Complications occurred in 11 (2.7%) patients. High body mass index (26.4 ± 3.4 vs. 23.3 ± 3.7, p = 0.007), larger tumor size (1.7 ± 1.3 cm. vs. 1.1 ± 1.0 cm, p = 0.012), larger thyroid volume (20.0 ± 9.2 vs. 12.8 ± 8.5, p = 0.007) and long operation time (127.8 ± 45.0 min. vs. 97.7 ± 38.5 min., p = 0.008) were significantly associated with complications in un-matched analyses. Older age (42.7 ± 8.0 vs. 34.9 ± 9.2, p = 0.023), high BMI (26.7 ± 3.2 vs. 23.3 ± 3.7, p = 0.012), and longer operation time (160.1 ± 54.1 min. vs. 97.4 ± 37.8, p = 0.001) were significantly related to conversion in un-matched analyses. However, significance was lost after PSM for both complication and conversion. The data from this study conducted on TOETVA cases do not suggest a risk factor for complications and conversion with PSM.
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Affiliation(s)
- Ziya Karimov
- Medicine Program, Ege University Faculty of Medicine, Izmir, Turkey
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, South Korea
| | - Yigit Turk
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey
| | - Gianlorenzo Dionigi
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | | | - Murat Ozdemir
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey
| | - Francesco Frattini
- Division of Surgery, Istituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifco), Milan, Italy
| | - Semiha Ozgul
- Department of Biostatistics and Medical Informatics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Ozer Makay
- Division of Endocrine Surgery, Department of General Surgery, Ege University Hospital, Bornova, 35100, Izmir, Turkey.
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25
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Zheng Y, Lv H, Lin Z, Shi H, Huang X. A nomogram to predict conversion of laparoscopic surgery to laparotomy for Choledocholithiasis. BMC Surg 2023; 23:372. [PMID: 38066500 PMCID: PMC10709908 DOI: 10.1186/s12893-023-02275-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Laparoscopic surgery is effective for treating common bile duct (CBD) stones. However, it has high requirements for surgeons and the risk of conversion to laparotomy cannot be ignored. However, when conditions during surgery are not favorable, persisting with laparoscopic procedures blindly can lead to serious complications. Our study aimed to establish a nomogram model for predicting conversion of laparoscopic to laparotomy for choledocholithiasis. MATERIALS AND METHODS A total of 867 patients who were diagnosed with choledocholithiasis and underwent laparoscopic surgery were randomly divided into a training group (70%, n = 607) and a validation group (30%, n = 260). A nomogram was constructed based on the results of logistic regression analysis. The area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA) were used to assess the predictive performance of the nomogram. RESULTS Previous upper abdominal surgery, maximum diameter of stone ≥12 mm, medial wall of the duodenum stone, thickening of the gallbladder wall, thickening of CBD wall, stone size/CBD size ≥0.75, and simultaneous laparoscopic hepatectomy were included in the nomogram. The AUC values were 0.813 (95% CI: 0.766-0.861) and 0.804 (95% CI: 0.737-0.871) in the training and validation groups, respectively. The calibration curve showed excellent consistency between the nomogram predictions and actual observations. DCA showed a positive net benefit for the nomogram. CONCLUSIONS We constructed a nomogram with a good ability to predict conversion to open surgery in laparoscopic surgery for choledocholithiasis, which can help surgeons to make a reasonable operation plan before surgery and timely convert to laparotomy during operation to reduce potential harm to the patient.
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Affiliation(s)
- Yitao Zheng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Haoyang Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Zhuoqun Lin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China
| | - Hongqi Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
| | - Xiaming Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
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26
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Pina L, Parker DM, Wood GC, Smith B, Petrick AT, Obradovic V. Laparoscopic sleeve gastrectomy conversion to gastric bypass: conversion rate over time, predictors of conversion, and weight loss outcomes. Surg Obes Relat Dis 2023:S1550-7289(23)00824-9. [PMID: 38155076 DOI: 10.1016/j.soard.2023.11.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/01/2023] [Accepted: 11/28/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is the most common Bariatric procedure in the United States; however, the frequency of conversion to Roux-en-Y gastric bypass (RYGB) is unknown. OBJECTIVES The primary aim was to determine the conversion rate over time from LSG to RYGB. The secondary objectives were to evaluate factors associated with conversion and postconversion weight loss outcomes. SETTING Single Academic Institution, Center of Bariatric Excellence. METHODS A retrospective analysis of all LSG from 2011 to 2020 was done. Kaplan-Meier analysis was utilized to estimate the conversion rate over time after LSG. Cox regression was utilized to identify predictors of future conversion. RESULTS Of 875 LSGs, 46 were converted to RYGB from 2011 to 2020. Median follow-up was 2.6 years, and 7-year follow-up rate was 59.9%. The 1-year conversion rate was 1.4%, increasing to 3.8%, 9.0%, and 12.6% at 3, 5, and 7 years respectively. Female gender (hazard ratio [HR] = 4.2, P = .05) and age <55 (HR = 3.5, P = .04) were associated with greater chance of conversion. Preoperative asthma (HR = 1.7, P = .14) and gastroesophageal reflux disease (GERD) (HR = 1.5, P = .18) trended toward higher conversion but were not significant. Of those with body mass index (BMI) >35 at time of conversion, the mean total body weight loss (TBWL) was 13.0% at the time of conversion. This subgroup had additional 13.6% of TBWL 1-year after conversion. CONCLUSIONS Conversion of LSG to RYGB increased with time to 12.6% conversion rate at 7-years. Patients with GERD prior to LSG had a nonsignificant trend toward conversion, while younger patients and females had significantly higher rates of conversion. There may be additional weight loss benefit for patients converted to RYGB.
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Affiliation(s)
- Luis Pina
- Division of Bariatric and Foregut Surgery and The Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - David M Parker
- Division of Bariatric and Foregut Surgery and The Obesity Institute, Geisinger Health System, Danville, Pennsylvania.
| | - G Craig Wood
- Division of Bariatric and Foregut Surgery and The Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - Benjamin Smith
- Division of Bariatric and Foregut Surgery and The Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - Anthony T Petrick
- Division of Bariatric and Foregut Surgery and The Obesity Institute, Geisinger Health System, Danville, Pennsylvania
| | - Vladan Obradovic
- Division of Bariatric and Foregut Surgery and The Obesity Institute, Geisinger Health System, Danville, Pennsylvania
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27
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Ntinopoulos V, Haeussler A, Odavic D, Papadopoulos N, Rings L, Dushaj S, Rodriguez Cetina Biefer H, Dzemali O. Conversion from off-pump to on-pump coronary artery bypass grafting: impact of surgeon and anaesthetist experience. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad205. [PMID: 38123498 PMCID: PMC10751234 DOI: 10.1093/icvts/ivad205] [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] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Intraoperative conversion from off-pump to on-pump coronary artery bypass grafting (CABG) is associated with increased postoperative morbidity and mortality. The aim of this study is to assess the impact of surgeon and anaesthetist experience on the conversion rate. METHODS We performed a retrospective analysis of the data of all patients who underwent planned off-pump CABG in a single centre in 2007-2021, some of whom were non-electively converted to on-pump. Surgeon and anaesthetist experience were assessed by the number of off-pump bypass procedures per year. Multivariable logistic regression analysis was used to assess the impact of surgeon and anaesthetist experience on conversion rate. RESULTS A total of 2742 patients met the inclusion criteria. Ninety-four (3.4%) patients underwent non-elective conversion to on-pump surgery. Converted patients had significantly higher mortality [11 (11.7%) vs 35 (1.3%), P < 0.0001] in comparison to non-converted patients. Anaesthetist experience was found to be a risk factor for conversion (P = 0.011). Surgeon experience did not significantly affect conversion rate (P = 0.51). Other risk factors for conversion were female gender [odds ratio 2.65 (95% confidence interval 1.65-4.26), P = 0.0001] and left ventricular ejection fraction ≤35% [odds ratio 1.91 (95% confidence interval 1.05-3.49), P = 0.040]. CONCLUSIONS Conversion from off-pump to on-pump CABG is associated with worse postoperative outcomes. Limited experience of anaesthetists in off-pump bypass surgery is associated with a higher conversion rate.
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Affiliation(s)
- Vasileios Ntinopoulos
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Dragan Odavic
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Nestoras Papadopoulos
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Laura Rings
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Stak Dushaj
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
| | - Hector Rodriguez Cetina Biefer
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
- Department of Cardiac Surgery, Municipal Hospital of Zurich—Triemli, Zurich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), Department of Cardiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Sylla P, Sands D, Ricardo A, Bonaccorso A, Polydorides A, Berho M, Marks J, Maykel J, Alavi K, Zaghiyan K, Whiteford M, Mclemore E, Chadi S, Shawki SF, Steele S, Pigazzi A, Albert M, DeBeche-Adams T, Moshier E, Wexner SD. Multicenter phase II trial of transanal total mesorectal excision for rectal cancer: preliminary results. Surg Endosc 2023; 37:9483-9508. [PMID: 37700015 PMCID: PMC10709232 DOI: 10.1007/s00464-023-10266-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 06/27/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Transanal TME (taTME) combines abdominal and transanal dissection to facilitate sphincter preservation in patients with low rectal tumors. Few phase II/III trials report long-term oncologic and functional results. We report early results from a North American prospective multicenter phase II trial of taTME (NCT03144765). METHODS 100 patients with stage I-III rectal adenocarcinoma located ≤ 10 cm from the anal verge (AV) were enrolled across 11 centers. Primary and secondary endpoints were TME quality, pathologic outcomes, 30-day and 90-day outcomes, and stoma closure rate. Univariable regression analysis was performed to assess risk factors for incomplete TME and anastomotic complications. RESULTS Between September 2017 and April 2022, 70 males and 30 females with median age of 58 (IQR 49-62) years and BMI 27.8 (IQR 23.9-31.8) kg/m2 underwent 2-team taTME for tumors located a median 5.8 (IQR 4.5-7.0) cm from the AV. Neoadjuvant radiotherapy was completed in 69%. Intersphincteric resection was performed in 36% and all patients were diverted. Intraoperative complications occurred in 8% including 3 organ injuries, 2 abdominal and 1 transanal conversion. The 30-day and 90-day morbidity rates were 49% (Clavien-Dindo (CD) ≥ 3 in 28.6%) and 56% (CD ≥ 3 in 30.4% including 1 mortality), respectively. Anastomotic complications were reported in 18% including 10% diagnosed within 30 days. Higher anastomotic risk was noted among males (p = 0.05). At a median follow-up of 5 (IQR 3.1-7.4) months, 98% of stomas were closed. TME grade was complete or near complete in 90%, with positive margins in 2 cases (3%). Risk factors for incomplete TME were ASA ≥ 3 (p = 0.01), increased time between NRT and surgery (p = 0.03), and higher operative blood loss (p = 0.003). CONCLUSION When performed at expert centers, 2-team taTME in patients with low rectal tumors is safe with low conversion rates and high stoma closure rate. Mid-term results will further evaluate oncologic and functional outcomes.
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Affiliation(s)
- Patricia Sylla
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA.
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA.
| | - Dana Sands
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Alison Ricardo
- Division of Colon and Rectal Surgery, Mount Sinai Hospital, New York, NY, USA
| | | | | | - Mariana Berho
- Executive Administration Florida, Cleveland Clinic Florida, Weston, FL, USA
| | - John Marks
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Justin Maykel
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA
| | - Karim Alavi
- Division of Colon and Rectal Surgery, UMass Memorial Medical Center, Worcester, MA, USA
| | - Karen Zaghiyan
- Division of Colorectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Mark Whiteford
- Gastrointestinal and Minimally Invasive Surgical Division, The Oregon Clinic, Providence Cancer Center, Portland, OR, USA
| | - Elisabeth Mclemore
- Division of Colorectal Surgery, Department of Surgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Sami Chadi
- Division of Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre and University Health Network, Toronto, ON, Canada
| | - Sherief F Shawki
- Department of Colorectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Scott Steele
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - Matthew Albert
- Department of Colon and Rectal Surgery, Advent Health Orlando, Orlando, FL, USA
| | | | - Erin Moshier
- Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA
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Lachance AD, Edelstein A, Stilwell M, Lutton J. No Difference in Range of Motion, Components, or Complications Following Conversion of Robotic-Assisted Total Knee Arthroplasty Compared to Manual TKA After Undergoing Manual or Robotic-Assisted Unicompartmental Knee Arthroplasty. Arthroplast Today 2023; 24:101269. [PMID: 38023646 PMCID: PMC10679885 DOI: 10.1016/j.artd.2023.101269] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/09/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Conversion surgery from unicondylar knee arthroplasty (UKA) to total knee arthroplasty (TKA) remains a challenge due to scarring, implant/cement removal, and loss of bony landmarks. Robotic-assisted (RA) TKA may assist in challenges seen in manual conversion TKA. The aim of this study is to identify if there are differences in components and functional outcomes dependent on manual/RA primary UKA and conversion TKA. Methods A retrospective chart review was performed on patients undergoing conversion from UKA to TKA over a 10-year period at a single institution. Data extracted included surgical technique, reason for UKA failure, range of motion at 1 year, need for augments, and utilization of revision components. Results Forty-nine patients (50 knees) with a UKA converted to a TKA were divided into 4 groups based on primary and conversion surgery: manual-to-manual (n = 11), manual-to-robot (n = 11), robot-to-manual (n = 11), and robot-to-robot (n = 17). There was no difference in need for augments (P = .376), size of poly (P = .23), postoperative flexion (P = .52), or extension (P = .76) at 1 year between the 4 groups. However, patients with primary manual UKA did require significantly more augments during revision (P = .032). Conclusions Our study did not show any statistically significant differences of primary RA or manual UKA to RA or manual TKA in terms of range of motion at 1 year, complications, or differences in components. RA conversion from UKA to TKA is a new but equivalent technique to manual conversion. Primary surgery may impact the requirement for augments during conversion surgery.
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Affiliation(s)
| | | | - Mason Stilwell
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - Jeffrey Lutton
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
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30
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Gudmundsdottir H, Fiorentini G, Essaji Y, D'Souza D, Torres-Ruiz T, Geller DA, Helton WS, Hogg ME, Iannitti DA, Kamath AS, Onkendi EO, Serrano PE, Simo KA, Sucandy I, Warner SG, Alseidi A, Cleary SP. Circumstances and implications of conversion from minimally invasive to open liver resection: a multi-center analysis from the AMILES registry. Surg Endosc 2023; 37:9201-9207. [PMID: 37845532 DOI: 10.1007/s00464-023-10431-0] [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: 05/04/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Minimally invasive approaches to liver resection (MILR) are associated with favorable outcomes. The aim of this study was to determine the implications of conversion to an open procedure on perioperative outcomes. METHODS Patients who underwent MILR at 10 North American institutions were identified from the Americas Minimally Invasive Liver Resection (AMILES) database. Outcomes of patients who required conversion were compared to those who did not. Additionally, outcomes after conversion due to unfavorable findings (poor visualization/access, lack of progress, disease extent) versus intraoperative events (bleeding, injury, cardiopulmonary instability) were compared. RESULTS Of 1675 patients who underwent MILR, 102 (6.1%) required conversion. Conversion rate ranged from 4.4% for left lateral sectionectomy to 10% for right hepatectomy. The primary reason for conversion was unfavorable findings in 67 patients (66%) and intraoperative adverse events in 35 patients (34%). By multivariable analysis, major resection, cirrhosis, prior liver surgery, and tumor proximity to major vessels were identified as risk factors for conversion (p < 0.05). Patients who required conversion had higher blood loss, transfusion requirements, operative time, and length of stay, (p < 0.05). They also had higher major complication rates (23% vs. 5.2%, p < 0.001) and 30-day mortality (8.8% vs. 1.3%, p < 0.001). When compared to those who required conversion due to unfavorable findings, patients who required conversion due to intraoperative adverse events had significantly higher major complication rates (43% vs. 14%, p = 0.012) and 30-day mortality (20% vs. 3.0%, p = 0.007). CONCLUSIONS Conversion from MILR to open surgery is associated with increased perioperative morbidity and mortality. Conversion due to intraoperative adverse events is rare but associated with significantly higher complication and mortality rates, while conversion due to unfavorable findings is associated with similar outcomes as planned open resection. High-risk patients may benefit from early conversion in a controlled fashion if difficulties are encountered or anticipated.
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Affiliation(s)
| | - Guido Fiorentini
- Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | | | | | | | - David A Geller
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | | | | | - Edwin O Onkendi
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | | | | | | | - Susanne G Warner
- Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Adnan Alseidi
- Virginia Mason Medical Center, Seattle, WA, USA
- University of California San Francisco, San Francisco, CA, USA
| | - Sean P Cleary
- Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
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Jörg M, Öster M, Wretborn J, Wilhelms DB. Agreement of pCO 2 in venous to arterial blood gas conversion models in undifferentiated emergency patients. Intensive Care Med Exp 2023; 11:80. [PMID: 37989791 PMCID: PMC10663424 DOI: 10.1186/s40635-023-00564-w] [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: 08/21/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Venous blood gas sampling has replaced arterial sampling in many critically ill patients, though interpretation of venous pCO2 still remains a challenge. Lemoël et al., Farkas and Zeserson et al. have proposed models to estimate arterial pCO2 based on venous pCO2. Our objective was to externally validate these models with a new dataset. This was a prospective cross-sectional study of consecutive adult patients with a clinical indication for blood gas analysis in an academic emergency department in Sweden. Agreement of pairs was reported as mean difference with limits of agreement (LoA). Vital signs and lead times were recorded. RESULTS Two hundred and fifty blood gas pairs were collected consecutively between October 2021 and April 2022, 243 valid pairs were used in the final analysis [mean age 72.8 years (SD 17.8), 47% females]. Respiratory distress was the most common clinical indication (84% of all cases). The model of Farkas showed the best metrics with a mean difference between estimated and arterial pCO2 of - 0.11 mmHg (95% LoA - 6.86, + 6.63). For Lemoël the difference was 2.57 mmHg (95% LoA - 5.65, + 10.8), Zeserson 2.55 mmHg (95% LoA - 7.43, + 12.53). All three models showed a decrease in precision in patients with ongoing supplemental oxygen therapy. CONCLUSION Arterial pCO2 may be accurately estimated in most patients based on venous blood gas samples. Additional consideration is required in patients with hypo- or hypercapnia or oxygen therapy. Thus, conversion of venous pCO2 may be considered as an alternative to arterial blood gas sampling with the model of Farkas being the most accurate.
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Affiliation(s)
- Matthias Jörg
- Department of Emergency Medicine, Sundsvall Regional Hospital, Region Västernorrland, Sundsvall, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden.
| | - Malin Öster
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden
| | - Jens Wretborn
- Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden
| | - Daniel B Wilhelms
- Department of Biomedical and Clinical Sciences, Linköping University, 58185, Linköping, Sweden
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden
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Boru CE, Marinari GM, Olmi S, Gentileschi P, Morino M, Anselmino M, Foletto M, Bernante P, Piazza L, Perrotta N, Morganti R, Silecchia G. Trends and safety of bariatric revisional surgery in Italy: multicenter, prospective, observational study. Surg Obes Relat Dis 2023; 19:1270-1280. [PMID: 37391349 DOI: 10.1016/j.soard.2023.05.009] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Revisional bariatric surgery (RBS) represents a further solution for patients who experience inadequate weight loss (IWL) following primary bariatric surgery (BS) or significant weight regain (WR) following initial satisfactory response. RBS guidelines are lacking; however, an increased trend in further BS offerings has been reported recently. OBJECTIVE Analyze trend, mortality, complication, readmission, and reoperation rates for any reason at 30 days after RBS in Italy. SETTING Ten Italian high-volume BS centers (university hospitals and private centers). METHODS Prospective, observational, multicenter study enrolling patients undergoing RBS between October 1, 2021, and March 31, 2022, registering reasons for RBS, technique, mortality, intraoperative and perioperative complications, readmissions, and reinterventions for any reason. Patients undergoing RBS during the same calendar interval in 2016-2020 were considered control patients. RESULTS A total of 220 patients were enrolled and compared with 560 control-group patients. Mortality was .45% versus .35% (n.s), with an overall mortality of .25%, while open surgery or conversion to open surgery was registered in 1%. No difference was found for mortality, morbidity, complications, readmission (1.3%), and reoperation rates (2.2%). IWL/WR was the most frequent cause, followed by gastroesophageal reflux disease; Roux-en-Y gastric bypass was the most used revisional procedure (56%). Sleeve gastrectomy was the most revised procedure in the study group, while gastric banding was the most revised in the control group. RBS represents up to 9% of the total BS in the Italian participating centers. CONCLUSIONS Laparoscopy represents the standard approach for RBS, which appears safe. Current Italian trends show a shift toward sleeve gastrectomy being the most revised procedure and Roux-en-Y gastric bypass being the most frequent revisional procedure.
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Affiliation(s)
- Cristian E Boru
- General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy.
| | - Giuseppe M Marinari
- Bariatric Unit, Humanitas Clinical and Research Hospital, IRCCS Rozzano, Milan, Italy
| | - Stefano Olmi
- General and Oncological Surgery Department, Center of Bariatric Surgery, Policlinico San Marco di Zingonia, Bergamo, Italy
| | - Paolo Gentileschi
- Bariatric and Metabolic Surgery Department, San Carlo of Nancy Hospital and "Tor Vergata" University of Rome, Rome, Italy
| | - Mario Morino
- General Surgery, Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Mirto Foletto
- Bariatric Surgery Unit, Azienda Ospedaliera of University of Padova, Padova, Italy
| | - Paolo Bernante
- Metabolic and Obesity Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for the Study and Research of Treatment for Morbid Obesity, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luigi Piazza
- General Surgery and Emergency Department, ARNAS Garibaldi Nesima Hospital, Catania, Italy
| | - Nicola Perrotta
- General Surgery Department, Villa d'Agri Hospital, Potenza, Italy
| | | | - Gianfranco Silecchia
- General Surgery Division, Department of Medical Surgical Sciences and Biotechnologies and Department of Medical Surgical Sciences and Translational Medicine, University "La Sapienza" of Rome, Rome, Italy
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Caballero N, Machiraju S, Diomino A, Kennedy L, Kadivar A, Cadenhead KS. Recent Updates on Predicting Conversion in Youth at Clinical High Risk for Psychosis. Curr Psychiatry Rep 2023; 25:683-698. [PMID: 37755654 PMCID: PMC10654175 DOI: 10.1007/s11920-023-01456-2] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent advances in the prediction and treatment of psychotic conversion. Over the past 25 years, research into the prodromal phase of psychotic illness has expanded with the promise of early identification of individuals at clinical high risk (CHR) for psychosis who are likely to convert to psychosis. RECENT FINDINGS Meta-analyses highlight conversion rates between 20 and 30% within 2-3 years using existing clinical criteria while research into more specific risk factors, biomarkers, and refinement of psychosis risk calculators has exploded, improving our ability to predict psychotic conversion with greater accuracy. Recent studies highlight risk factors and biomarkers likely to contribute to earlier identification and provide insight into neurodevelopmental abnormalities, CHR subtypes, and interventions that can target specific risk profiles linked to neural mechanisms. Ongoing initiatives that assess longer-term (> 5-10 years) outcome of CHR participants can provide valuable information about predictors of later conversion and diagnostic outcomes while large-scale international biomarker studies provide hope for precision intervention that will alter the course of early psychosis globally.
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Affiliation(s)
- Noe Caballero
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Siddharth Machiraju
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Anthony Diomino
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Leda Kennedy
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Armita Kadivar
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA
| | - Kristin S Cadenhead
- Department of Psychiatry, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093-0810, USA.
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Masuda T, Endo Y, Amano S, Kawamura M, Fujinaga A, Kawasaki T, Kawano Y, Hirashita T, Ohta M, Inomata M. Appropriate indications for laparoscopic repeat hepatectomy. BMC Surg 2023; 23:322. [PMID: 37875912 PMCID: PMC10594730 DOI: 10.1186/s12893-023-02208-y] [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: 06/23/2023] [Accepted: 09/28/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Laparoscopic repeat hepatectomy (LRH) has increased, but appropriate indications for LRH are unclear. This study aimed to clarify appropriate indications for LRH. METHODS We retrospectively compared surgical outcomes between open RH (ORH) (n = 57) and LRH (n = 40) groups. To detect difficult cases of complete pure LRH, we examined patients with unplanned intraoperative hand-assisted laparoscopic surgery (HALS)/open conversion (n = 6). RESULTS In the LRH versus ORH group, as previous hepatectomy, laparoscopic (75% vs. 12%, p < 0.001) and partial hepatectomy (Hr0) (73% vs. 37%, p = 0.002) were more frequently performed, and as RH procedure, partial hepatectomy (Hr0) (88% vs. 47%, p = 0.0002) was more frequently performed. S1 tumor cases were higher in ORH group (11% vs. 0%), but S2-6 cases were higher in LRH group (73% vs. 49%) (p = 0.02). In LRH group, compared to the pure LRH patients, HALS/open conversion patients underwent significantly more previous hepatectomy with more than lobectomy (Hr2-3) (33% vs. 2.9%, p = 0.033) and more RH procedures with segmentectomy (HrS) (33% vs. 2.9%, p = 0.03). All LRH requiring a repeat hepatic hilar approach were HALS conversions. CONCLUSION Appropriate indications for LRH were previous hepatectomy was laparoscopic partial hepatectomy (Hr0), and RH procedure was partial hepatectomy (Hr0) for S2-6 tumor location. When RH is more than segmentectomy (HrS) requiring a repeat hepatic hilar approach, planned HALS or ORH may be a better approach than pure LRH.
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Affiliation(s)
- Takashi Masuda
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan.
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Shota Amano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Masahiro Kawamura
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Atsuro Fujinaga
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Takahide Kawasaki
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Yoko Kawano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Teijiro Hirashita
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Idaigaoka 1-1, Hasama-machi, Oita, 879-5593, Japan
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Pan H, Li B, Yang J, Liu W, Luo W, Chen B. Iodine revisited: If and how inorganic iodine species can be measured reliably and what cause their conversions in water? J Hazard Mater 2023; 460:132423. [PMID: 37657323 DOI: 10.1016/j.jhazmat.2023.132423] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/20/2023] [Accepted: 08/26/2023] [Indexed: 09/03/2023]
Abstract
This study revisited a list of inorganic iodine species on their detections and conversions under different water conditions. Several surprising results were found, e.g., UV-vis spectrophotometry is the only reliable method for I3- and I2 determinations with coexisting I-/IO3-/IO4-, while alkaline eluent of IC and LC columns can convert them into I- completely; IO4- can be converted into IO3- completely in IC columns and partly in LC columns; a small portion of IO3- was reduced to I- in LC columns. To avoid errors, a method for detecting multiple coexisting iodine species is suggested as follows: firstly, detecting I3- and I2 via UV-vis spectrophotometry; then, analyzing IO4- (> 0.2 mg/L) through LC; and lastly, obtaining I- and IO3- concentrations by deducting I- and IO3- measured by IC from the signals derived from I3-/I2/IO4-. As for stability, I- or IO3- alone is stable, but mixing them up generates I2 or H2OI+ under acidic conditions. Although IO4- is stable within pH 4.0-8.0, it becomes H5IO6/H3IO62- in strongly acidic/alkaline solutions. Increasing pH accelerates the conversions of I3- and I2 into I- under basic conditions, whereas dissolved oxygen and dosage exert little effect. Additionally, spiking ICl into water produces I2 and IO3- rather than HIO.
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Affiliation(s)
- Huimei Pan
- State Key Laboratory of Urban Water Resource and Environment, Shenzhen Key Laboratory of Organic Pollution Prevention and Control, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Boqiang Li
- State Key Laboratory of Urban Water Resource and Environment, Shenzhen Key Laboratory of Organic Pollution Prevention and Control, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Jie Yang
- State Key Laboratory of Urban Water Resource and Environment, Shenzhen Key Laboratory of Organic Pollution Prevention and Control, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Wenzhe Liu
- State Key Laboratory of Urban Water Resource and Environment, Shenzhen Key Laboratory of Organic Pollution Prevention and Control, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Wang Luo
- State Key Laboratory of Urban Water Resource and Environment, Shenzhen Key Laboratory of Organic Pollution Prevention and Control, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China
| | - Baiyang Chen
- State Key Laboratory of Urban Water Resource and Environment, Shenzhen Key Laboratory of Organic Pollution Prevention and Control, Harbin Institute of Technology (Shenzhen), Shenzhen 518055, China.
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Handojo K, Ismaeil A, Van Huele A, Van Neste C, Debergh I, Dillemans B. Roux-en-Y Gastric Bypass as Conversion Procedure of Failed Gastric Banding: Short-Term Outcomes of 1295 Patients in One Single Center. Obes Surg 2023; 33:2963-2972. [PMID: 37548925 PMCID: PMC10514178 DOI: 10.1007/s11695-023-06746-5] [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: 02/19/2023] [Revised: 06/30/2023] [Accepted: 07/14/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Laparoscopic adjustable gastric band (LAGB) has high technical and weight loss failure rates. We evaluate here the 1-year morbidity, mortality, and weight loss of laparoscopic Roux-en-Y-gastric bypass (LRYGB) as a feasible conversion strategy. METHODS Patients with a failed primary LAGB who underwent LRYGB from July 2004 to December 2019 were selected from an electronic database at our center. Patients had a conversion to LRYGB at the same time (one-stage approach) or with a minimum of 3 months in between (two-stage approach). Primary outcomes included 30-day morbidity and mortality. Secondary outcomes were body mass index (BMI), percent excess weight loss (%EWL), and percent excess BMI lost (%EBMIL) at 1 year postoperatively. RESULTS A total of 1295 patients underwent a conversion from LAGB to LRYGB at our center: 1167 patients (90.1%) in one stage and 128 patients (9.9%) in two stages. There was no mortality. An early (30-day) postoperative complication occurred in 93 patients (7.2%), with no significant difference found between groups. Hemorrhage was the most common complication in 39 patients (3.0%), and the reoperation was required in 19 patients (1.4%). At 1 year postoperatively, the mean BMI was 28.0 kg/m2, the mean %EWL 72.8%, and the mean %EBMIL 87.0%. No statistically significant difference was found between the groups. CONCLUSION Conversion to LRYGB can be considered as a safe and effective option with low complication rate and good weight loss outcomes at 1 year. One-stage conversion provides the same early outcome as two-step surgery with a competent surgeon.
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Affiliation(s)
- Karen Handojo
- Department of General Surgery, AZ Sint Jan Brugge-Oostende AV, Campus Henri Serruys, 8400 Oostende, Belgium
| | - Aiman Ismaeil
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, 81528 Egypt
| | - Andries Van Huele
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Isabelle Debergh
- Department of General Surgery, AZ Delta Hospital, Sint-Rembertlaan 21, 8820, Torhout, Belgium
| | - Bruno Dillemans
- Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium
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Moein M, Dvorai RH, Li BW, Fioramonti PJ, Schilsky JB, Thankachan R, Yang C, Saidi RF, Shahbazov R. Early conversion to belatacept-based immunosuppression regimen promotes improved long-term renal graft function in kidney transplant recipients. Transpl Immunol 2023; 80:101882. [PMID: 37392898 DOI: 10.1016/j.trim.2023.101882] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/12/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Belatacept has been demonstrated as an effective alternative immunosuppressant in kidney transplant recipients. This study focuses on outcomes of early and late conversion to Belatacept-based immunosuppression after kidney transplant. MATERIALS AND METHODS This retrospective analysis of a prospectively collected database included all adult kidney transplants patients at SUNY Upstate Medical Hospital from 1 January 2014 to 30 December 2022. Early conversion was defined as all conversions done at <6 months after kidney transplantation, and late conversion to belatacept was defined as conversion at >6 months after kidney transplantation. RESULTS Out of 61 patients included in this study, 33 patients (54%) were in the early conversion group, and 28 patients (46%) were in the late conversion group. The mean eGFR in the early conversion group was 26.73 ± 16.26 ml/min/1.73 m2 before conversion to belatacept, which improved to 45.3 ± 21.01 ml/min/1.73 m2 at one-year post-conversion (p = 0.0006). Furthermore, eGFR changes in the late conversion group were insignificant, with 46.30 ± 15.65 ml/min/1.73 m2 before conversion to belatacept, and 44.76 ± 22.91 ml/min/1.73 m2 after one year of follow-up (p = 0.72). All four biopsy-proven allograft rejections in the early conversion group were acute T-cell-mediated rejections (ATMR). In the late conversion group, out of three biopsy-proven rejections, one was chronic antibody-mediated rejection (CAMR), one was ATMR, and one was mixed ATMR/CAMR. All four patients with ATMR rejection received mycophenolic acid (MPA) as part of their immunosuppressive regimen, and none received tacrolimus. The one-year post-conversion allograft survival rate in early and late conversion groups was 100%. However, the one-year post-conversion patient survival rate was 90.9% in the early conversion group and 100% in the late conversion group (P = 0.11). CONCLUSIONS Early post-transplant conversion to belatacept can improve the eGFR more meaningful when compared to late conversion. Patients who receive belatacept and MPA rather than tacrolimus may have increased rates of T-cell-mediated rejection.
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Affiliation(s)
- Mahmoudreza Moein
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Reut Hod Dvorai
- Department of Pathology and Laboratory Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Benson W Li
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - P J Fioramonti
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Juliana B Schilsky
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Reeba Thankachan
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christine Yang
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Reza F Saidi
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Rauf Shahbazov
- Department of Surgery, Division of Transplantation, SUNY Upstate Medical University, Syracuse, NY, USA.
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Ndong A, Diallo AC, Rouhi AD, Diao ML, Yi W, Tendeng JN, Williams NN, Cissé M, Dumon KR, Konaté I. Factors associated with conversion in laparoscopic surgery in a low-resource setting: a single-center prospective study. Surg Endosc 2023; 37:8072-8079. [PMID: 37640956 DOI: 10.1007/s00464-023-10373-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/30/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Laparoscopy has a clear patient benefit related to postoperative morbidity but may not be as commonly performed in low-and middle-income countries. The decision to convert to laparotomy can be complex and involve factors related to the surgeon, patient, and procedure. The objective of this work is to analyze the factors associated with conversion in laparoscopic surgery in a low-resource setting. METHODS This is a single-center prospective study of patients who underwent laparoscopic surgery between May 1, 2018 and October 31, 2021. The parameters studied were age, sex, body mass index (BMI), intraoperative complication (e.g., accidental enterotomy, hemorrhage), equipment malfunction (e.g., technical failure of the equipment, break in CO2 supply line), operating time, and conversion rate. RESULTS A total of 123 laparoscopic surgeries were performed. The average age of patients was 31.2 years (range 11-75). The procedures performed included appendix procedures (48%), followed by gynecological (18.7%), gallbladder (14.6%), digestive (10.56%), and abdominal procedures (4%). The average length of hospitalization was 3 days (range 1-16). Conversion to laparotomy was reported in 8.9% (n = 11) cases. Equipment malfunction was encountered in 9.8% (n = 12) cases. Surgical complications were noted in 11 cases (8.9%). Risk factors for conversion were shown to be BMI > 25 kg/m2 (OR 4.6; p = 0.034), intraoperative complications (OR 12.6; p = 0.028), and equipment malfunction (OR 9.4; p = 0.002). CONCLUSION A better understanding of the underlying factors associated with high conversion rates, such as overweight/obesity, intraoperative complications, and equipment failure, is the first step toward surgical planning to reduce postoperative morbidity in low-resource settings.
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Affiliation(s)
- Abdourahmane Ndong
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint-Louis, Senegal.
| | - Adja C Diallo
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint-Louis, Senegal
| | - Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mohamed L Diao
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint-Louis, Senegal
| | - William Yi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacques N Tendeng
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint-Louis, Senegal
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Mamadou Cissé
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint-Louis, Senegal
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ibrahima Konaté
- Department of Surgery, Saint-Louis Regional Hospital, Gaston Berger University, Road of Ngallelle, 234, Saint-Louis, Senegal
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O'Laughlin M, Cornejo J, Zevallos A, Coker A, Schweitzer M, Adrales G, Li C, Sebastian R. Laparoscopic sleeve gastrectomy to Roux-en-Y gastric bypass conversion versus primary Roux-en-Y gastric bypass: a propensity score matching analysis. Surg Endosc 2023; 37:7947-7954. [PMID: 37433912 DOI: 10.1007/s00464-023-10261-0] [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: 04/04/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Secondary bariatric surgery rates have increased, accounting for approximately 19% of the total bariatric cases in the last years, most commonly conversion of sleeve gastrectomy to gastric bypass. Using the MBSAQIP, we evaluate the outcomes of this procedure compared to the primary RYGB surgery. METHODS The new variable, conversion of sleeve gastrectomy to RYGB in the 2020 and 2021 MBSAQIP database was analyzed. Patients who underwent primary laparoscopic RYGB and those who underwent laparoscopic sleeve gastrectomy to RYGB conversion were identified. Using Propensity Score Matching analysis, the cohorts were matched for 21 preoperative characteristics. We then compared 30-day outcomes and bariatric-specific complications between primary RYGB and conversion from sleeve gastrectomy to RYGB. RESULTS There were 43,253 primary RYGB procedures performed and 6,833 conversions from sleeve gastrectomy to RYGB. The matched cohorts (n = 5912) for the two groups have similar pre-operative characteristics. Propensity-matched outcomes showed that conversion from sleeve gastrectomy to RYGB was associated with more readmissions (6.9% vs 5.0%, p < 0.001), interventions (2.6% vs 1.7%, p < 0.001), conversion to open (0.7% vs 0.2%, p < 0.001), length of stay (1.79 ± 1.77 days vs 1.62 ± 1.66 days, p < 0.001), and operative time (119.16 ± 56.82 min vs 138.27 ± 66.00, p < 0.001). There were no significant differences in mortality (0.1% vs 0.1%, p = 0.405), and bariatric-specific complications such as anastomotic leak (0.5% vs 0.4%, p = 0.585), intestinal obstruction (0.1% vs 0.2%, p = 0.808), internal hernia (0.2% vs 0.1%, p = 0.285) or anastomotic ulcer (0.3% vs 0.3%, p = 0.731) rates. CONCLUSION Conversion from sleeve gastrectomy to RYGB is a safe and feasible operation with reasonable outcomes compared with primary RYGB.
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Affiliation(s)
- Michael O'Laughlin
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Jorge Cornejo
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Alba Zevallos
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
- Universidad Cientifica del Sur, Lima, Peru
| | - Alisa Coker
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | | | - Gina Adrales
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Christina Li
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA
| | - Raul Sebastian
- Department of Surgery, Northwest Hospital, 5401 Old Court Road, Randallstown, MD, 21133, USA.
- Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
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Abdelaal AM, Khalifa AA. Total knee arthroplasty post-high tibial osteotomy, results of an early experience from a North African arthroplasty unit, and a comprehensive review of the literature. J Orthop Surg Res 2023; 18:705. [PMID: 37730629 PMCID: PMC10510125 DOI: 10.1186/s13018-023-04199-1] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023] Open
Abstract
PURPOSE To report an early experience after converting HTO to TKA by reporting the incidence of functional, radiological, and complications in a single surgeon case series from a North African specialized arthroplasty unit. METHODS Between 2010 and 2020, 33 knees in 31 patients (two bilateral) were operated upon, 24 females and seven males, had a mean age of 65 ± 4.5 years; 17 (51.5%) knees had medial wedge opening (WMO), while 16 (48.5%) had lateral wedge closure (LWC) osteotomies. The mean time from HTO to TKA was 8.1 ± 3.3 years. A posterior stabilized (PS) implant was used in 31 (93.9%), while in 2 (6.1%), a varus-valgus constrained (VVC) implant was used. A tibial stem was needed in 13 (39.4%) knees. The functional assessment was performed according to the Knee Society Scoring System (KSS). The radiographic assessment included the anatomical femorotibial angle (aFTA) for alignment, the medial proximal tibial angle (MPTA), and the tibial slope (TS). RESULTS After a mean follow-up of 4.3 ± 1.1 years, the KSS knee and function sub-scores improved from a preoperative mean of 41 ± 8.9 (26 to 57) and 37.7 ± 9.2 (25 to 55) points to 91.3 ± 3.8 (81 to 94) and 85.5 ± 5 (80 to 95) points at the last follow-up, respectively (P < 0.05). The preoperative knee flexion improved from a mean of 84.5° ± 15.9 (55 to 110) to 110.6° ± 9.3 (95 to 125) (P < 0.05). The aFTA improved from a preoperative mean of 182.2° ± 10.3 (164 to 205) to a postoperative mean of 186° ± 2.6 (179 to 190) (P < 0.05). The MPTA changed from a preoperative mean of 88.4° ± 6.7 (77 to 102) to a postoperative (tibial component alignment) mean of 90° ± 1.7 (85 to 94) (P < 0.05). The mean preoperative TS changed from 80.9° ± 7.3 (68 to 96) to a mean postoperative of 86.9° ± 1.3 (83 to 89) (P < 0.05). Non-progressive radiolucent lines were detected at the tibial component in four (12%) knees. Complications were reported in seven (21.2%) knees; no revision was needed in any knee. CONCLUSIONS The authors' early experience showed improved functional and radiological outcomes; however, the complication incidence was relatively high, but no knees required revision. A longer follow-up is mandatory to prove the consistency of the results.
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Affiliation(s)
- Ahmed M Abdelaal
- Orthopaedic Department, Assiut University Hospital, Assiut, Egypt
- Hospital for Advanced Orthopaedics, Assiut, Egypt
| | - Ahmed A Khalifa
- Hospital for Advanced Orthopaedics, Assiut, Egypt.
- Orthopedics Department, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, 83523, Egypt.
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Deng M, Zhao R, Guan R, Li S, Zuo Z, Lin W, Wei W, Guo R. Development of nomograms to predict recurrence after conversion hepatectomy for hepatocellular carcinoma previously treated with transarterial interventional therapy. Eur J Med Res 2023; 28:328. [PMID: 37689775 PMCID: PMC10492285 DOI: 10.1186/s40001-023-01310-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Lack of opportunity for radical surgery and postoperative tumor recurrence are challenges for surgeons and hepatocellular carcinoma (HCC) patients. This study aimed to develop nomograms to predict recurrence risk and recurrence-free survival (RFS) probability after conversion hepatectomy for patients previously receiving transarterial interventional therapy. METHODS In total, 261 HCC patients who underwent conversion liver resection and previously received transarterial interventional therapy were retrospectively enrolled. Nomograms to predict recurrence risk and RFS were developed, with discriminative ability and calibration evaluated by C-statistics, calibration plots, and the Area under the Receiver Operator Characteristic (AUROC) curves. RESULTS Univariate/multivariable logistic regression and Cox regression analyses were used to identify predictive factors for recurrence risk and RFS, respectively. The following factors were selected as predictive of recurrence: age, tumor number, microvascular invasion (MVI) grade, preoperative alpha-fetoprotein (AFP), preoperative carbohydrate antigen 19-9 (CA19-9), and Eastern Cooperative Oncology Group performance score (ECOG PS). Similarly, age, tumor number, postoperative AFP, postoperative protein induced by vitamin K absence or antagonist-II (PIVKA-II), and ECOG PS were incorporated for the prediction of RFS. The discriminative ability and calibration of the nomograms revealed good predictive ability. Calibration plots showed good agreement between the nomogram predictions of recurrence and RFS and the actual observations. CONCLUSIONS A pair of reliable nomograms was developed to predict recurrence and RFS in HCC patients after conversion resection who previously received transarterial interventional therapy. These predictive models can be used as guidance for clinicians to help with treatment strategies.
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Affiliation(s)
- Min Deng
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Rongce Zhao
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Renguo Guan
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Shaohua Li
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Zhijun Zuo
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Wenping Lin
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Wei Wei
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Rongping Guo
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China.
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Campbell S, Toker A. Conversions due to oncology and technical reasons versus emergency conversions: 'the experienced surgeon'. Eur J Cardiothorac Surg 2023; 64:ezad281. [PMID: 37584680 DOI: 10.1093/ejcts/ezad281] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/12/2023] [Indexed: 08/17/2023] Open
Affiliation(s)
- Stuart Campbell
- West Virginia University, School of Medicine, Department of Cardiovascular and Thoracic Surgery, Morgantown, WV, USA
| | - Alper Toker
- West Virginia University, School of Medicine, Department of Cardiovascular and Thoracic Surgery, Morgantown, WV, USA
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Dirnberger AS, Süsstrunk J, Schneider R, Poljo A, Klasen JM, Slawik M, Billeter AT, Müller-Stich BP, Peterli R, Kraljević M. Mid-Term Outcomes After Conversion Procedures Following Laparoscopic Sleeve Gastrectomy. Obes Surg 2023; 33:2679-2686. [PMID: 37515694 PMCID: PMC10435413 DOI: 10.1007/s11695-023-06734-9] [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: 05/08/2023] [Revised: 07/07/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE In the long term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss (IWL), gastroesophageal reflux disease (GERD), and persistence or relapse of associated medical problems. This study's objective is to present mid-term results regarding weight loss (WL), evolution of associated medical problems, and reoperation rate of patients who underwent a conversion after SG. METHODS Retrospective single-center analysis of patients with a minimal follow-up of 2 years after conversion. RESULTS In this series of 549 SGs, 84 patients (15.3%) underwent a conversion, and 71 met inclusion criteria. They were converted to short biliopancreatic limb Roux-en-Y gastric bypass (short BPL RYGB) (n = 28, 39.4%), biliopancreatic diversion with duodenal switch (BPD/DS) (n = 19, 26.8%), long biliopancreatic limb Roux-en-Y gastric bypass (long BPL RYGB) (n = 17, 23.9%), and re-sleeve gastrectomy (RSG) (n = 7, 9.9%). Indications were GERD (n = 24, 33.8%), IWL (n = 23, 32.4%), IWL + GERD (n = 22, 31.0%), or stenosis/kinking of the sleeve (n = 2, 2.8%). The mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m2. The mean follow-up time after conversion was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and long BPL RYGB (32.9%) compared to RSG (20.0%; p = 0.004; p = 0.049). In case of GERD, conversion to Roux-en-Y gastric bypass (RYGB) led to a resolution of symptoms in 79.5%. 16.9% of patients underwent an additional revisional procedure. CONCLUSION In the event of IWL after SG, conversion to BPD/DS provides a significant and sustainable additional WL. Conversion to RYGB leads to a reliable symptom control in patients suffering from GERD after SG.
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Affiliation(s)
- Amanda S Dirnberger
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Julian Süsstrunk
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Romano Schneider
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Adisa Poljo
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Jennifer M Klasen
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Marc Slawik
- Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Clara Hospital, CH-4058, Basel, Switzerland
| | - Adrian T Billeter
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
| | - Beat P Müller-Stich
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
- Department of Clinical Research, University of Basel, CH-4031, Basel, Switzerland
| | - Ralph Peterli
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland.
- Department of Clinical Research, University of Basel, CH-4031, Basel, Switzerland.
| | - Marko Kraljević
- University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland
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Okuno M, Ishii T, Ichida A, Soyama A, Takemura N, Hirono S, Eguchi S, Hasegawa K, Sasaki Y, Uemura K, Kokudo N, Hatano E. Protocol of the RACB study: a multicenter, single-arm, prospective study to evaluate the efficacy of resection of initially unresectable hepatocellular carcinoma with atezolizumab combined with bevacizumab. BMC Cancer 2023; 23:780. [PMID: 37605169 PMCID: PMC10440857 DOI: 10.1186/s12885-023-11302-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/13/2022] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Although the standard therapy for advanced-stage hepatocellular carcinoma (HCC) is systemic chemotherapy, the combination of atezolizumab and bevacizumab (atezo + bev) with a high objective response rate may lead to conversion to resection in patients with initially unresectable HCC. This study aims to evaluate the efficacy of atezo + bev in achieving conversion surgery and prolonged progression-free survival (PFS) for initially unresectable HCC. METHODS The RACB study is a prospective, single-arm, multicenter, phase II trial evaluating the efficacy of combination therapy with atezo + bev for conversion surgery in patients with technically and/or oncologically unresectable HCC. The main eligibility criteria are as follows: (1) unresectable HCC without a history of systemic chemotherapy, (2) at least one target lesion based on RECIST ver. 1.1, and (3) a Child‒Pugh score of 5-6. The definition of unresectable tumors in this study includes macroscopic vascular invasion and/or extrahepatic metastasis and massive distribution of intrahepatic tumors. Patients will be treated with atezolizumab (1200 mg/body weight) and bevacizumab (15 mg/kg) every 3 weeks. If the patient is considered resectable on radiological assessment 12 weeks after initial chemotherapy, the patient will be treated with atezolizumab monotherapy 3 weeks after combination chemotherapy followed by surgery 3 weeks after atezolizumab monotherapy. If the patient is considered unresectable, the patient will continue with atezo + bev and undergo a radiological assessment every 9 weeks until resectable or until disease progression. The primary endpoint is PFS, and the secondary endpoints are the overall response rate, overall survival, resection rate, curative resection rate, on-protocol resection rate, and ICG retention rate at 15 min after atezo + bev therapy. The assessments of safety and quality of life during the treatment course will also be evaluated. The number of patients has been set at 50 based on the threshold and the expected PFS rate at 6 months after enrollment of 40% and 60%, respectively, with a one-sided alpha error of 0.05 and power of 0.80. The enrollment and follow-up periods will be 2 and 1.5 years, respectively. DISCUSSION This study will elucidate the efficacy of conversion surgery with atezo + bev for initially unresectable HCC. In addition, the conversion rate, safety and quality of life during the treatment course will also be demonstrated. TRIAL REGISTRATION This study is registered in the Japan Registry of Clinical Trials (jRCTs051210148, January 7, 2022).
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Affiliation(s)
- Masayuki Okuno
- Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya Hyogo, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Akihiko Ichida
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nobuyuki Takemura
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Seiko Hirono
- Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya Hyogo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuharu Sasaki
- Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, JCRAC Data Center, Tokyo, Japan
| | - Kohei Uemura
- Department of Biostatistics and Bioinformatics, Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
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Gowd AK, Plate JF, Lichtig A, Gencer A, Yanmis O, D'Agostino R, Poehling GG. Favourable mid-term outcomes following unicompartmental knee arthroplasty with wider patient selection: A single-centre experience. J ISAKOS 2023; 8:255-260. [PMID: 37004741 DOI: 10.1016/j.jisako.2023.03.002] [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: 08/24/2022] [Revised: 02/17/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE The purpose of this study was to determine surgical outcomes of robotic-assisted UKAs utilizing a wider set of indications than traditionally utilized. Additionally, we seek to determine alternate predictive factors as potential surgical indications and contraindications. METHODS A prospectively maintained institutional joint registry was queried at a single academic centre for all patients that underwent robotic-assisted UKA between January 2010-December 2016. Surgical indication included isolated medial or lateral compartment degenerative disease with a stable knee based on physical exam. In 2013, haemoglobin A1C levels over 7.5% were considered contraindications, which was lowered to 7.0% in 2015. Preoperative alignment, age, activity level and degree of pain were not contraindications for surgery. Preoperative demographics, Oxford scores, radiographic (joint space), comorbidities and operative data were collected and reviewed to determine factors related to conversion to TKA and survivorship of the primary implant. RESULTS In total, 1878 cases were performed; however, excluding multi-joint knees, there were a total of 1186 knees in 1014 patients with a minimum 4-year follow-up. The mean age was 63.4 ± 10.7 years and mean follow-up was 76.4 ± 17.4 months. Mean BMI was 32.3 ± 6.5 kg/m2. (52.9% females, 47.1% males). There were 901 patients undergoing medial UKA, 122 patients undergoing lateral UKA and 69 patients undergoing patellofemoral UKA. In total, 85 (7.2%) knees underwent conversion to TKA. Preoperative factors such as the degree of preoperative valgus deformity (p = 0.01), greater operative joint space (p = 0.04), previous surgery (p = 0.01), inlay implant (p = 0.04) and pain syndrome (p = 0.01) were associated with increased risk of revision surgery. Factors associated with decreased implant survivorship included patients with history of previous surgery (p < 0.01), history of pain syndrome (p < 0.01) and greater preoperative joint space (>2 mm) (p < 0.01). There was no association of BMI to conversion to TKA. CONCLUSION Robotic-assisted UKA with wider patient selection demonstrated favourable outcomes at 4 years with survivorship greater than 92%. The present series agree with emerging indications that do not exclude patients based on age, BMI, or degree of deformity. However, increased operative joint space, inlay design, history of surgery and coexistence of pain syndrome are factors that increase risk of conversion to TKA. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Anirudh K Gowd
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Johannes F Plate
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Asher Lichtig
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
| | - Ahmet Gencer
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Orhan Yanmis
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Ralph D'Agostino
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA
| | - Gary G Poehling
- Department of Orthopaedic Surgery Wake Forest Medical Center Watlington Hall, 4th Floor 1 Medical Center Boulevard, Winston Salem, NC 27157, USA.
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Anatone AJ, Uppstrom TJ, Fletcher C, Baral E, Gomoll AH, Strickland SM. Patellofemoral arthroplasty conversion to total knee arthroplasty: An updated retrieval analysis and clinical outcomes. Knee 2023; 43:28-33. [PMID: 37210859 DOI: 10.1016/j.knee.2023.04.019] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND A prior retrieval analysis found high rates of infection after conversion of PFA to TKA, but was limited by a small sample size. The purpose of this study is to perform a retrieval analysis with clinical correlation on an expanded group of patients to better understand conversion of PFA to TKA. METHOD A retrospective review of an implant retrieval registry identified 62 conversions of PFA to TKA between 2004-2021. Implants were analyzed for wear pattern and cement fixation. Patient charts were reviewed for demographic information, perioperative data, prior and subsequent surgical procedures, complications and outcomes. Radiographs performed prior to index PFA and conversion procedures were assessed for KL grading. RESULTS Cement fixation was present on 86% of retrieved components and wear was more pronounced on the lateral side. The most common indication for conversion to TKA was progression of OA in 46.8% of patients, followed by unexplained pain in the absence of radiographic or clinical changes (37.1%), loosening (8.1%), mechanical symptoms (4.8%), traumatic (3.2%). Thirteen patient experienced complications requiring additional procedures including arthrofibrosis (n = 4, 7.3%), PJI (n = 3, 5.5%), instability (n = 3, 5.5%), hematoma (n = 2, 3.6%) and loosening (n = 1, 1.8%). Revision components were used in 1.8% of cases and average post-conversion arc of motion was 119 degrees. CONCLUSIONS The most common reason for PFA conversion to TKA was progression of osteoarthritis. PFA conversion to TKA is technically similar to primary TKA, but complication rates are more consistent with revision TKA in this study.
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Affiliation(s)
- Alex J Anatone
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.
| | - Tyler J Uppstrom
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Connor Fletcher
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Elexis Baral
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
| | - Andreas H Gomoll
- Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA
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Zhou X, Liu Z, Ma Y, Zhang C, Wu Y. A mathematical algorithm to harmonize measurements for thyroid-stimulating hormone between instruments. Clin Chim Acta 2023; 548:117513. [PMID: 37562523 DOI: 10.1016/j.cca.2023.117513] [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: 05/15/2023] [Revised: 07/24/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Thyroid-stimulating hormone (TSH) is measured differently between diagnostic units using different devices, which makes cross-comparisons challenging. Here, we have developed a mathematical algorithm to harmonize TSH measurements between 2 instruments, the Abbott ISR2000 and the Siemens ADVIA Centaur XP. METHODS Applying the principle of the maximum allowable error between the standard curve and real signal values, the minimum number of comparison samples required for TSH hormone detection was calculated for both instruments. Next, a mathematical algorithm describing the relationship between TSH standard curves from both instruments was established. The algorithm was then tested on sample measurements from both instruments, with signals transformed to Siemens ADVIA Centuar XP-type data. Finally, test results were assessed where the relative error was RESULTS Before conversion, the mean percentage error between the TSH results of samples measured on both instruments was 23.20% (>1/2 TEa). After algorithmic transformation, the average percentage error was reduced to 7.93% (<1/2 TEa). CONCLUSIONS Our algorithm enables TSH measurements across different instruments to be comparable, and provides a method to harmonize TSH data between laboratories that utilize different instrumentation.
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Affiliation(s)
- Xin Zhou
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China; Jintang First People's Hospital, Chengdu 610400, China
| | - Zaishuan Liu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yining Ma
- College of Mathematics of Sichuan University, Chengdu 610065, China
| | - Chongwei Zhang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yongkang Wu
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China; Jintang First People's Hospital, Chengdu 610400, China.
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Wang Z, Sheveleva AM, Lee D, Chen Y, Iuga D, Franks WT, Ma Y, Li J, Li L, Cheng Y, Daemen LL, Days SJ, Ramirez‐Cuesta AJ, Han B, Eggeman AS, McInnes EJL, Tuna F, Yang S, Schröder M. Modulation of Uptake and Reactivity of Nitrogen Dioxide in Metal-Organic Framework Materials. Angew Chem Int Ed Engl 2023; 62:e202302602. [PMID: 37027005 PMCID: PMC10962595 DOI: 10.1002/anie.202302602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/20/2023] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023]
Abstract
We report the modulation of reactivity of nitrogen dioxide (NO2 ) in a charged metal-organic framework (MOF) material, MFM-305-CH3 in which unbound N-centres are methylated and the cationic charge counter-balanced by Cl- ions in the pores. Uptake of NO2 into MFM-305-CH3 leads to reaction between NO2 and Cl- to give nitrosyl chloride (NOCl) and NO3 - anions. A high dynamic uptake of 6.58 mmol g-1 at 298 K is observed for MFM-305-CH3 as measured using a flow of 500 ppm NO2 in He. In contrast, the analogous neutral material, MFM-305, shows a much lower uptake of 2.38 mmol g-1 . The binding domains and reactivity of adsorbed NO2 molecules within MFM-305-CH3 and MFM-305 have been probed using in situ synchrotron X-ray diffraction, inelastic neutron scattering and by electron paramagnetic resonance, high-field solid-state nuclear magnetic resonance and UV/Vis spectroscopies. The design of charged porous sorbents provides a new platform to control the reactivity of corrosive air pollutants.
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Affiliation(s)
- Zi Wang
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
- Photon Science InstituteUniversity of ManchesterManchesterM13 9PLUK
| | - Alena M. Sheveleva
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
- Photon Science InstituteUniversity of ManchesterManchesterM13 9PLUK
| | - Daniel Lee
- Department of Chemical Engineering and Analytical ScienceUniversity of ManchesterManchesterM13 9PLUK
| | - Yinlin Chen
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
| | - Dinu Iuga
- Department of PhysicsUniversity of WarwickCoventryCV4 7ALUK
| | | | - Yujie Ma
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
| | - Jiangnan Li
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
| | - Lei Li
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
| | - Yongqiang Cheng
- Neutron Scattering DivisionOak Ridge National LaboratoryOak RidgeTN 37831USA
| | - Luke L. Daemen
- Neutron Scattering DivisionOak Ridge National LaboratoryOak RidgeTN 37831USA
| | - Sarah J. Days
- Diamond Light SourceHarwell Science CampusOxfordshireOX11 0DEUK
| | | | - Bing Han
- Department of MaterialsUniversity of ManchesterManchesterM13 9PLUK
| | | | - Eric J. L. McInnes
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
- Photon Science InstituteUniversity of ManchesterManchesterM13 9PLUK
| | - Floriana Tuna
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
- Photon Science InstituteUniversity of ManchesterManchesterM13 9PLUK
| | - Sihai Yang
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
| | - Martin Schröder
- Department of ChemistryUniversity of ManchesterManchesterM13 9PLUK
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Fuga M, Tanaka T, Tachi R, Tomoto K, Wachi R, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Predicting difficult transradial approach guiding into left internal carotid artery on unruptured intracranial aneurysms. Surg Neurol Int 2023; 14:233. [PMID: 37560592 PMCID: PMC10408647 DOI: 10.25259/sni_355_2023] [Citation(s) in RCA: 1] [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: 04/23/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND The transradial approach (TRA) is less invasive than the transfemoral approach (TFA), but the higher conversion rate represents a drawback. Among target vessels, the left internal carotid artery (ICA) is particularly difficult to deliver the guiding catheter to through TRA. The purpose of this study was thus to explore anatomical and clinical features objectively predictive of the difficulty of delivering a guiding catheter into the left ICA via TRA. METHODS Among 78 consecutive patients who underwent coil embolization for unruptured intracranial aneurysms through TRA in a single institution between March 1, 2021, and August 31, 2022, all 29 patients (37%) who underwent delivery of the guiding catheter into the left ICA were retrospectively analyzed. Clinical and anatomical features were analyzed to assess correlations with difficulty in guiding the catheter into the left ICA. RESULTS Of the 29 aneurysms requiring guidance of a catheter into the left ICA, 9 aneurysms (31%) required conversion from TRA to TFA. More acute innominate-left common carotid artery (CCA) angle (P < 0.001) and older age (P = 0.015) were associated with a higher conversion rate to TFA. Receiver operating characteristic analysis revealed that optimal cutoff values for the innominate-left CCA angle and age to distinguish between nonconversion and conversion to TFA were 16° (area under the curve [AUC], 0.93; 95% confidence interval [CI], 0.83-1.00) and 74 years (AUC, 0.79; 95% CI, 0.61-0.96), respectively. CONCLUSION A more acute innominate-left CCA angle and older age appear associated with difficulty delivering the guiding catheter into the left ICA for neurointervention through TRA.
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Affiliation(s)
- Michiyasu Fuga
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihide Tanaka
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Rintaro Tachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Kyoichi Tomoto
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Ryoto Wachi
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Akihiko Teshigawara
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Yuzuru Hasegawa
- Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
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Carle-Toulemonde G, Goutte J, Do-Quang-Cantagrel N, Mouchabac S, Joly C, Garcin B. Overall comorbidities in functional neurological disorder: A narrative review. Encephale 2023:S0013-7006(23)00086-6. [PMID: 37414721 DOI: 10.1016/j.encep.2023.06.004] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION The importance to assess and include the frequent comorbidities in the personalised care management plan of patients with functional neurological disorders (FND) has arisen through the years. FND patients are not only complaining from motor and/or sensory symptoms. They also report some non-specific symptoms that participate to the burden of FND. In this narrative review, we aim to better describe these comorbidities in terms of prevalence, clinical characteristics and their variability depending on the subtype of FND. METHODS The literature was searched for on Medline and PubMed. The search was narrowed to articles between 2000 and 2022. RESULTS Fatigue is the most common symptom reported in relation to FND (from 47 to 93%), followed by cognitive symptoms (from 80 to 85%). Psychiatric disorders are reported in 40 to 100% FND patients, depending on the FND subtype (functional motor disorder [FMD], functional dissociative seizures [FDS]…) but also on the type of psychiatric disorder (anxiety disorders being the most frequent, followed by mood disorders and neurodevelopmental disorders). Stress factors such as childhood trauma exposure (emotional neglect and physical abuse predominantly) have also been identified in up to 75% of FND patients, along with maladaptive coping strategies. Organic disorders are commonly reported in FND, such as neurological disorders (including epilepsy in FDS [20%] and FMD in Parkinson's Disease [7%]). Somatic symptom disorders including chronic pain syndromes are frequently associated to FND (about 50%). To be noted, recent data also suggest a high comorbidity between FND and hypermobile Ehlers Danlos Syndrome (about 55%). CONCLUSION Put together, this narrative review highlights the high burden of FND patients, not only due to somatosensory alterations but also by considering the frequent comorbidities reported. Thus, such comorbidities must be taken into consideration when defining the FND personalised care management strategy for the patients.
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Affiliation(s)
| | - Julie Goutte
- Internal Medicine Department, Saint-Etienne University Hospital, Saint-Priest-en-Jarez, France
| | | | - Stéphane Mouchabac
- Sorbonne University, Department of Psychiatry, AP-HP, Saint-Antoine University Hospital, Paris, France
| | - Charlotte Joly
- Neurology Department, Assistance Publique-Hôpitaux de Paris, AP-HP Avicenne University Hospital, Bobigny, France
| | - Béatrice Garcin
- Neurology Department, Assistance Publique-Hôpitaux de Paris, AP-HP Avicenne University Hospital, Bobigny, France
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