Quadriparesis from air emboli during percutaneous nephrolithotomy

Quadriparesis is a potentially catastrophic complication during operative procedures. It may result from a number of different types of central nervous system insults. A case of quadriparesis following an otherwise unremarkable percutaneous nephrolithotomy surgery is reported. The quadriparesis resulted from multiple air micro emboli.     

Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre,randomised, double-blinded trial

Purpose

Recent clinical data suggest that terlipressin, a vasopressin analogue, may be more beneficial in septic shock patients than catecholamines. However, terlipressin’s effect on mortality is unknown. We set out to ascertain the efficacy and safety of continuous terlipressin infusion compared with norepinephrine (NE) in patients with septic shock.

Methods

In this multicentre, randomised, double-blinded trial, patients with septic shock recruited from 21 intensive care units in 11 provinces of China were randomised (1:1) to receive either terlipressin (20–160 µg/h with maximum infusion rate of 4 mg/day) or NE (4–30 µg/min) before open-label vasopressors. The primary endpoint was mortality 28 days after the start of infusion. Primary efficacy endpoint analysis and safety analysis were performed on the data from a modified intention-to-treat population.

Results

Between 1 January 2013 and 28 February 2016, 617 patients were randomised (312 to the terlipressin group, 305 to the NE group). The modified intention-to-treat population comprised 526 (85.3%) patients (260 in the terlipressin group and 266 in the NE group). There was no significant difference in 28-day mortality rate between the terlipressin group (40%) and the NE group (38%) (odds ratio 0.93 [95% CI 0.55–1.56]; p?=?0.80). Change in SOFA score on day 7 was similar between the two groups: ??7 (IQR ??11 to 3) in the terlipressin group and ??6 (IQR ??10 to 5) in the NE group. There was no difference between the groups in the number of days alive and free of vasopressors. Overall, serious adverse events were more common in the terlipressin group than in the NE group (30% vs 12%; p?<?0.001).

Conclusions

In this multicentre, randomised, double-blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of serious adverse events.

Trial registration

This trial is registered at ClinicalTrials.gov: ID NCT01697410.

     

Diagnosing pituitary adenoma in unstained sections based on multiphoton microscopy

Purpose

If we can find a new method that can achieve rapid diagnosis of adenoma during operation, it will help surgeon shorten the operation time and enhance the treatment efficacy. This study discusses the feasibility of multiphoton microscopy (MPM) in diagnosing pituitary adenoma.

Method

MPM, based on two-photon excited fluorescence (TPEF) and second harmonic generation (SHG) is performed for the diagnosis of pituitary adenoma in unstained sections.

Results

Our results show that MPM can reveal the variation of reticulin fiber by SHG signals of collagen, combined with the measurement of area of acinus, thickness of collagen fiber and collagen percentage. MPM can further reflect the change of meshwork in normal pituitary and hyperplasia quantitatively. And the characteristics of typical growth patterns of pituitary adenoma are demonstrated by the overlay of SHG and TPEF images. What’s more, we can identify the boundary of normal pituitary, hyperplasia and adenoma from MPM images. And the experiment also results verify the feasibility of this method in frozen sections.

Conclusion

These results indicated that MPM can make a diagnosis of pituitary adenoma by the morphological changes without routine pathological processing including hematoxylin-eosin (H&E) staining and other special staining. Therefore, this technique is expected to help diagnosis of pituitary adenoma during operation.

     

Transurethral enucleation of the prostate versus transvesical open prostatectomy for large benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials

Purpose

To evaluate the efficacy and safety of transurethral enucleation of the prostate (TUEP) versus transvesical open prostatectomy (OP) for the management of large benign prostatic hyperplasia (BPH).

Methods

Randomized controlled trials (RCTs) comparing TUEP and OP were identified from PubMed, Embase and Web of Science up to February 28, 2015. A meta-analysis was conducted with the STATA 12.0 software.

Results

Nine RCTs including 758 patients were enrolled in our meta-analysis. There were no significant differences between the two groups in the maximum urinary flow rate at 1, 3, 6 months, 1 and 2 years: postvoiding residual urinary volume, prostate-specific antigen, international prostate symptom score and quality of life score at 1, 3, 6 months and 1 year; or international index of erectile function at 3, 6 months and 1 year. Perioperative outcomes including hemoglobin level drop, catheter period, irrigation length and hospital stay favored TUEP, while operative time and resected prostate weight favored OP. There was significantly less blood transfusion with TUEP, but no significant differences were found in other complications such as recatheterization, urinary tract infection, reintervention for clots and bleeding control, incidence of pneumonia and infarction, transient incontinence, bladder neck contracture, urethral stricture and recurrent adenoma.

Conclusions

TUEP can be performed effectively and safely with functional outcomes and complications similar to OP for large BPH, whereas it has the advantages of a shorter catheter period, shorter hospital stays and less blood transfusion. These findings seem to support TUEP as the next-generation “gold standard” of surgery for large BPH.

     

Psychosocial reactions to relocation to a nursing home among Chinese older adults

ObjectivesThis study aimed to describe the psychosocial reactions to relocation to a nursing home from the perspective of older adults.MethodThis study applied a qualitative interview design. Narratives from 23 Chinese nursing home residents in a life review program in Fuzhou, China were recorded, transcribed into sentences, and analyzed using qualitative content analysis.ResultsThe following psychosocial reactions to relocation to a nursing home emerged: fear, struggle, compromise, acceptance, and contribution. The fear resulted from negative labels attached to nursing homes, fear of disconnection to society, fear of difficulties in establishing new relationships, and fear of being abandoned by their families. The behaviors of ‘struggle’ were complaining about family members, thinking of returning home, praying for change, and taking action to leave. The keys to compromise were a choice between maintaining harmony in family relations and the companionship of relatives, a choice between professional care and family care, and a choice between the cost and effectiveness of family care and nursing home care. The process of acceptance included accepting life yet with worries, affirming the benefits of living in a nursing home, and embracing nursing home life. Contribution was mainly reflected in two aspects, a sense of ownership and bring into full play their self-worth.DiscussionsThis study generates new insights into knowledge on the psychosocial reactions to relocation to a nursing home. It provides both family members and nursing home staff with direction on how to ensure a smoother relocation process.     

Genetic characterization of 19 X-STRs in Sierra Leone population from Freetown

International Journal of Legal Medicine - A total of 550 individuals (265 males and 285 females) from Sierra Leone, a west-African coastal country, were genotyped using the Microreader™ 19X...     

A multi-center study of using carbon nanoparticles to track lymph node metastasis in T1–2 colorectal cancer

Background

How to identify whether T1–2 colorectal cancers have lymph nodes metastases pre-op or intra-op is a crucial problem in clinic. The purpose of this study was to evaluate the feasibility of using carbon nanoparticles to track lymph nodes metastases in T1–2 colorectal cancers.

Methods

A multi-center study was performed between July 2012 and January 2014. Seventy-three patients with T1–2 colorectal cancer identified by pre-op endoscopic ultrasonography (EUS) were recruited. 1 ml carbon nanoparticles suspension was endoscopically injected into the submucosal layer at four points around the site of the primary tumor 1 day before surgery. Laparoscopic radical resection with lymphadenectomy was performed. Sentinel lymph nodes (SLNs) were defined as nodes that were black-dyed by carbon nanoparticles. Pathology confirmed whether lymph nodes have cancer metastases and the SLNs accuracy.

Results

SLNs were easily found under laparoscopy. The mean number of SLNs was 3 (range 1–5). All patients had SLNs lying alongside the mesenteric vessel or main arterial vessel. After pathological analysis, 2 patients (9.52 %) had lymph node metastasis in 21 patients with EUS T1 cancers, and 10 patients (19.23 %) had lymph node metastasis in 52 patients with EUS T2 cancers. In two T1 cases with lymph node metastasis, SLNs were positive with 100 % accuracy. In ten T2 cases with lymph node metastasis, SLNs were positive in nine cases. In pathology, carbon nanoparticles were seen in lymphatic vessels, and lymphoid sinus and macrophages in negative SLNs. When SLNs were positive, carbon nanoparticles were seen around cancer cells in lymph nodes. The overall sensitivity, specificity, accuracy of SLNs in T1–2 colorectal cancers were 91.67, 100, 98.63 %, respectively.

Conclusions

We demonstrated the feasibility of using carbon nanoparticles to track lymph nodes metastases in T1–2 colorectal cancers. Carbon nanoparticles black-dyed lymph nodes play a role as SLNs in T1–2 colorectal cancers.     

Methylation status of the T-cadherin gene promotor in peripheral blood mononuclear cells is associated with HBV-related hepatocellular carcinoma progression

DNA methylation is one of the epigenetic mechanisms to regulate gene expression and frequently occurs in human cancer cells. T-cadherin (CDH13) is a new member of the cadherin superfamily and possesses multiple functions. Our study included 26 normal controls (NCs), 65 chronic hepatitis B patients (CHB), 14 liver cirrhosis patients (LC) and 157 hepatocellular carcinoma patients (HCC). We mainly focused on the mRNA expression and methylation status of CDH13 in peripheral blood mononuclear cells (PBMCs), which were detected by semi-quantitative real-time polymerase chain reaction (RT-qPCR) and methylation-specific polymerase chain reaction (MSP) respectively. The CDH13 mRNA level was lower in HCC, especially in early-stage of HCC than in NCs and CHB groups (p < 0.05). Methylation frequency of the CDH13 promoter was significantly higher in HCC patients than in the NCs and CHB groups (67.52 % vs 0.00 %, p < 0.001, 67.52 % vs 52.31 %, p < 0.05, respectively). CDH13 mRNA level was significantly and relatively lower in methylated groups than in unmethylated groups among the whole participants. The methylation level of CDH13 promoter in HCC might be influenced or partly influenced by some critical factors such as TBil, ALB and AFP (p < 0.05). As an important factor in signaling pathway regulating by CDH13 to promote carcinogenesis, JNK level was significantly higher in HCC which had a higher methylation frequency than in NCs, CHB and LC (p < 0.05). Furthermore, the combination of the methylated CDH13 level and AFP level showed a better score: AUC = 0.796 (SE = 0.031, 95 %CI 0.735–0.857; p < 0.001) in male and AUC = 0.832 (SE = 0.057, 95 %CI 0.721–0.944; p < 0.001) in female compared to AFP alone for diagnosing HCC from NCs, CHB and LC. The methylation of CDH13 promoter was an independent predictor for assessing the prognosis of HCC patients (r=-1.378 p < 0.05). In conclusion, hypermethylation of CDH13 in PBMCs was associated with the underexpression of mRNA and the high risk of HCC. The methylation status of the CDH13 promoter in PBMCs was a potential noninvasive biomarker to predict the prognosis of HCC patients.     

Decoding the Evolutionary Response to Ensartinib in Patients With ALK-Positive NSCLC by Dynamic Circulating Tumor DNA Sequencing

IntroductionBy implementing dynamic circulating tumor DNA (ctDNA) analysis, we explored the impact of TP53 mutations on tumor evolution and resistance mechanisms to ensartinib in patients with ALK-positive NSCLC.MethodsIn a multicenter phase 2 trial, patients with ALK-positive NSCLC who progressed on crizotinib were treated with ensartinib. Blood samples for ctDNA analysis were collected at baseline, cycle 3 day 1, and progression disease (PD) and analyzed with a 212-gene panel.ResultsA total of 440 samples were collected from 168 patients. Baseline TP53 mutations (20.2%) significantly correlated with inferior progression-free survival (4.2 mo versus 11.7 mo, p < 0.0001). Patients with TP53 mutations had higher mutation load than those without TP53 mutations at baseline (13.79 ± 3.72 versus 4.67 ± 0.39, p < 0.001). Although there was no significant difference in mutation load between these groups at cycle 3 day 1 (5.89 ± 2.25 versus 3.72 ± 0.62, p = 0.425), patients with mutated TP53 developed more mutations at PD (7.07 ± 1.25 versus 3.20 ± 0.33, p = 0.003). Frequency and abundance of secondary ALK mutations G1269A, G1202R, and E1210K increased markedly at PD than baseline. In patients without secondary ALK mutations, we identified ALK-independent resistance mechanisms including bypass signaling activation, downstream effector protein reactivation, epithelial-mesenchymal transformation, and epigenetic dysregulation.ConclusionsOur study highlighted the advantage of ctDNA analysis for monitoring tumor evolution. TP53 mutations promoted genetic evolution and accelerated occurrence of resistance. We also unveiled ALK-dependent resistance mechanisms, mainly by G1269A, G1202R, and E1210K mutations, and ALK-independent resistance mechanisms to ensartinib.