Preoperative prognostic predictors and treatment strategies for surgical procedure focused on the sequential organ failure assessment score in nonocclusive mesenteric ischemia: a multicenter retrospective cohort study

BACKGROUND

Several large-scale studies have assessed endovascular and surgical treatment methods for nonocclusive mesenteric ischemia (NOMI); however, the prognostic factors for NOMI remain unclear. Therefore, this study aimed to evaluate risk factors for in-hospital mortality among patients with NOMI who underwent laparotomy and to examine therapeutic strategies that may improve the prognosis.

MATERIALS AND METHODS

In this multicenter retrospective study, the authors reviewed the electronic medical records retrieved from the inpatient database of patients with NOMI at eight district general hospitals between January 2011 and January 2021. A total of 88 patients who underwent laparotomies were divided into survivor and nonsurvivor groups, and statistical analysis was performed to determine clinical and physiological factors.

RESULTS

Exploratory laparotomy based on second-look surgery was the first treatment choice. The overall mortality rate was 48.8%, with a male-to-female ratio of 1.1:1. The median Sequential Organ Failure Assessment (SOFA) score was 8 [interquartile range: 3.75-14.2], and the median SOFA scores were 5 [3-7] in the survivor group and 13 [9-17.5] in the nonsurvivor group. Univariate analysis revealed a significant difference in BMI ( P <0.001), hypoglycemia ( P =0.0012), previous cardiovascular surgery ( P =0.0019), catecholamine use ( P <0.001), SOFA score ( P <0.001), platelet count ( P =0.0023), and lactate level ( P <0.001). Logistic regression analysis using the factors with significant differences revealed that SOFA score ≥10 (odds ratio 23.3; 95% CI: 1.94-280.00; P =0.013) was an independent prognostic factor. In addition, catecholamine use was suggested as a factor with a SOFA score greater than or equal to 10.

CONCLUSION

This study confirmed that a SOFA score of greater than or equal to 10 may be associated with increased mortality. While closely monitoring low blood pressure and renal dysfunction, survival rates may be improved if surgical intervention is performed before the SOFA score reaches greater than or equal to 10.

An Autopsy Case of Amyotrophic Lateral Sclerosis with Diaphragm Pacing

Respiratory insufficiency is a critical problem in amyotrophic lateral sclerosis (ALS) patients. We herein present the case of an autopsied patient with sporadic ALS who underwent diaphragm pacing (DP). The pathology showed several localized adhesions with a markedly atrophied diaphragm. A marked loss of motor neurons with Bunina bodies and phosphorylated TDP-43 positive inclusions was found in the spinal cord and primary motor cortex. Mild hyalinization and a few multinucleated giant cells were present around the electrode tracks in the diaphragm. However, no infiltration of inflammatory cells was detected. Our findings suggest that full-time DP might not cause severe damage to adjacent diaphragm tissue.

Establishment and characterisation of an osteoblastic clonal cell line from human mandibular osteosarcoma (HMOS-1)

A human mandibular osteosarcoma cell line, HMOS-1, with osteoblastic phenotypes and tumor-genicity was established. The cell line showed high alkaline phosphatase (ALP) activity immediately after seeding, with its peak around the 7th to 10th day of culture (1.44 mumol/min/mg protein). Parathyroid hormone (PTH) enhanced the ALP activity as well as intracellular cAMP production in a concentration-dependent manner. The effects of PTH on both ALP activity and cAMP production were expressed more strongly at the end stage of logarithmic cell growth than at the resting stage. 1,25 (OH)2D3 also stimulated the ALP activity, but its effect was low and was not different in any of the different culture stages. When these cells were transplanted to BALB/C nude mice, similar tumours to the original one, with abundant osteoids were observed. However, th e synthesis of type 1 collagen was not detected in the culture medium. The results indicate that the HMOS-1 cell line expresses an immature pre-osteoblastic phenotype. Because of these characteristics, HMOS-1 cells should be useful, not only in studies on the differentiated phenotypes of human osteoblasts, but also in studies on the diagnosis, treatment and aetiology of human osteosarcoma of the jaw.