Application of automated peritoneal dialysis in urgent-start peritoneal dialysis patients during the break-in period

Objective

Whether automated peritoneal dialysis (APD) is a feasible strategy for urgent-start peritoneal dialysis (PD) therapy during the break-in period remains unclear. This study was conducted to compare the efficacy as well as complications among three PD modes during the break-in period.

Methods

Ninety-six patients treated with urgent-start PD after catheterization were retrospectively analyzed. Patients were divided into three groups, incremental continuous ambulatory PD (CAPD) group (n = 26); APD group (n = 42); and APD–CAPD group (n = 28). Clinical parameters at the end of the break-in period and 1 month after the initiation of PD treatment were collected and analyzed.

Results

Compared with the traditional incremental CAPD, APD and APD–CAPD were superior as they could effectively remove small-molecule uremic toxins and correct electrolyte imbalance (P < 0.05), while did not increase the incidence of early complications during the break-in period (P > 0.05). However, APD led to a significant decline in albumin and pre-albumin, as compared with APD–CAPD and CAPD (P < 0.05). A PD strategy consisting 6 days of APD and 3 days of CAPD showed a great advantage in preventing excessive protein loss. There were no significant differences in all tested biochemical parameters among the three groups at 1 month after treatment (all P > 0.05).

Conclusion

Application of APD for urgent-start PD during the break-in period is feasible. A combination of APD and CAPD regimens seems to be a more reasonable mode.

     

Greater Curvature Plication with Duodenal–Jejunal Bypass: a Novel Metabolic Surgery for Type 2 Diabetes Mellitus

Objective

The study investigated the use of great curvature plication with duodenal–jejunal bypass (GCP-DJB) in a type 2 diabetic with obesity rat model.

Methods

Twenty-two Sprague-Dawley rats were given a high fat and sugar diet with subsequent intraperitoneal injection of a small dosage of streptozotocin (30 mg/kg) and randomly assigned to either GCP-DJB (n?=?12) or Sham surgery (n?=?10). Body weight, peripheral blood glucose, and fasting serum insulin were assayed, and insulin resistance index (IRI) was calculated, before and at 1, 2, 4, and 8 weeks after surgery.

Results

No differences were found in the preoperative characteristics of the two groups (P?>?0.05). At week 1, the body weights decreased significantly, but there was no significant difference between the two groups (P?>?0.05).The fasting blood glucose was significantly lower in the GCP-DJB than in the Sham group (P?<?0.05), serum insulin levels were higher (P?<?0.05), and IRI began to decline (P?<?0.05). From 2 to 8 weeks, the body weight of Sham group gradually recovered and continued to rise, while the GCP-DJB group remained at a relatively lower state. Compared to the Sham group, the body weight, fasting blood glucose as well as IRI of GCP-DJB rats had significantly decreased (P?<?0.05). But, the fasting insulin concentrations had significantly increased (P?<?0.05).

Conclusion

This novel GCP-DJB procedure established a stable animal model for the study of metabolic surgery to treat type 2 diabetes mellitus (T2DM).

     

18-Fluorodeoxyglucose Positron Emission Tomography Predicts Recurrence in Resected Pancreatic Ductal Adenocarcinoma

Background

We aimed to determine whether treatment should be stratified according to 18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) maximum standardized uptake values (SUV_max) in pancreatic ductal adenocarcinoma.

Methods

Patients who underwent preoperative 18F-FDG PET/CT between 2006 and 2014 (n = 138) were stratified into high (≥ 4.85) and low (< 4.85) PET groups. The clinicopathological characteristics and prognostic outcomes were analyzed retrospectively.

Results

The primary tumor SUV_max was positively correlated with preoperative CA19-9 levels (P < 0.001). The high PET group failed to achieve postoperative CA19-9 normalization (P = 0.014). Disease-specific (P < 0.001), recurrence-free (P < 0.001), liver recurrence-free (P < 0.001), and peritoneal recurrence-free (P = 0.020) survivals were significantly shorter in the high PET group. The primary tumor SUV_max was an independent predictive risk factor for liver metastasis (hazard ratio 3.46, 95% confidence interval 1.61–7.87; P = 0.001) and peritoneal recurrence (hazard ratio 3.36, 95% confidence interval 1.18–10.89; P = 0.023).

Conclusions

Surgical resection failed to achieve CA19-9 normalization in the high PET group and distant recurrence was frequent. This suggests the potential for residual cancer at distant sites, even after curative resection. Stronger preoperative systemic chemotherapy is preferred for the high PET group patients.

     

The survival outcome and prognostic factors for distal cholangiocarcinoma following surgical resection: a meta-analysis for the 5-year survival

Purpose

To assess the available evidence on the prognostic factors for the 5-year survival for patients with distal cholangiocarcinoma (DCC) following surgical resection.

Methods

We performed a comprehensive search of abstracts included in databases where relevant studies were published between January 2000 and August 2015. Risk ratios (RRs), 95 % confidence intervals (95 % CIs), and random-effects model were calculated using RevMan 5.3 software.

Results

A total of 23 observational studies involving 2063 patients with DCC were analyzed. The meta-analysis showed that postoperative adjuvant chemotherapy was not confirmed as a prognostic factor, with similar 5-year survival rates between those receiving and not receiving chemotherapy (RR 0.71; 95 % CI 0.21–2.36; P = 0.57). Perineural invasion (RR 0.51; 95 % CI 0.40–0.64; P < 0.00001), lymph node metastasis (RR 0.51; 95 % CI 0.38–0.70; P < 0.0001), positive resection margin status (RR 2.11; 95 % CI 1.36–3.30; P = 0.001), and not-well-differentiated adenocarcinoma (RR 1.77; 95 % CI 1.39–2.25; P < 0.00001) were associated with shorter survival.

Conclusions

Perineural invasion, lymph node metastasis, resection margin status, and tumor differentiation were the significant prognostic factors for the 5-year survival.

     

Different Expression Patterns of CEACAM1 and its Impacts on Angiogenesis in Gastric Nonneoplastic and Neoplastic Lesions

Objective

This study was designed to investigate the expression patterns of CEACAM1 and its relationship with angiogenesis in nonneoplastic and neoplastic gastric lesions.

Methods

CEACAM1 and TGF-β expression was detected by immunohistochemical staining and dual-labeling immunohistochemical staining in neoplastic and nonneoplastic lesions. MVD-CD31 and MVD-CD105 were counted in CEACAM1-positive areas by dual-labeling immunohistochemistry.

Results

There was no expression of CEACAM1 in normal gastric mucosa. In IM and GIN, CEACAM1 was mainly expressed with membranous pattern. CEACAM1 was expressed with membranous pattern in well-differentiated adenocarcinoma, with cytoplasmic pattern in poorly differentiated adenocarcinoma, and with cytoplasmic and membranous pattern mixed together in intermediately adenocarcinoma. The expression patterns of CEACAM1 showed a significant difference (P < 0.05) in nonneoplastic and neoplastic lesions. Coexpression of CEACAM1 and TGF-β was elevated and significantly different from nonneoplastic to neoplastic lesions (P < 0.05). Moreover, CEACAM1 and TGF-β coexpression were related to carcinoma progression (r = 0.35; P < 0.05). MVD-CD31 and MVD-CD105 showed significant differences from nonneoplastic to neoplastic lesions (P < 0.05).

Conclusions

CEACAM1 has different expression patterns in nonneoplastic and neoplastic lesions. The coexpression of CEACAM1 and TGF-β increased from nonneoplastic to neoplastic lesions and may be related with tumor progression via promoting tumorous angiogenesis.

     

Impaired skeletal health and neuromuscular function among amphetamine users in clinical treatment

Summary

This study examined musculoskeletal health in amphetamine users, compared with healthy age-matched controls. We show that amphetamine users have reduced bone mass at several skeletal sites and attenuated maximal muscle strength and force development capacity in the lower extremities.

Introduction

Amphetamine use may cause poor bone quality and elevated risk of osteoporosis. The purpose of this study was to investigate whether amphetamine users exhibit reduced regional and whole body bone mineral density (BMD), altered bone metabolism, and how muscle function may relate to the patient groups’ skeletal health.

Methods

We assessed hip, lumbar spine and whole body BMD, and trabecular bone score (TBS) by dual x-ray absorptiometry (DXA), and bone metabolism markers in serum and maximal strength and force development capacity in 36 amphetamine users (25 men, 30?±?7 years; 11 women 35?±?10 years) and in 37 healthy controls (23 men, 31?±?9 years; 14 women, 35?±?7 years).

Results

Whole body BMD was lower in amphetamine users (8 % in males and 7 % females, p?<?0.01), as were BMD at the total hip and sub-regions of the hip (9–11 % in men and 10–11 % in women, p?<?0.05). Male users had 4 % lower TBS (p?<?0.05) and higher serum level of type 1 collagen amino-terminal propeptide (p?<?0.01). This coincided with reduced lower extremity maximal strength of 30 % (males, p?<?0.001) and 25 % (females, p?<?0.05) and 27 % slower muscular force development in males compared to controls (p?<?0.01).

Conclusions

These findings demonstrate that amphetamine users suffer from a generalized reduction in bone mass, which was associated with attenuated maximal muscle strength and force development capacity in the lower extremities.

     

Pre-treatment double- or triple-positive tumor markers are predictive of a poor outcome for patients undergoing radiofrequency ablation for hepatocellular carcinoma

Purposes

We evaluated the therapeutic effect of radiofrequency ablation (RFA) on hepatocellular carcinoma (HCC) according to the number of positive tumor markers.

Methods

The subjects of this study were 160 patients who underwent percutaneous and surgical RFA for HCC. Patients were divided into negative (n = 51), single- (n = 69), double- (n = 31), and triple-positive (n = 9) tumor marker groups according to the pre-treatment expression of these markers. We looked for any relationships among clinical parameters, outcomes, and tumor markers.

Results

The 3-year recurrence-free and overall survival rates of the negative, single-, double-, and triple-positive groups were 30, 19, 16, and 11 % (P = 0.02), and 94, 88, 67, and 37 % (P < 0.001), respectively. The 2-year local recurrence rates were 6.5, 0, 41.2, and 61.9 %, respectively (P < 0.001). Multivariate analysis revealed that a double- or triple-positive pre-treatment tumor marker profile was independently associated with local recurrence [hazard ratio (HR) 5.48, 95 % confidence interval (CI) 2.44–12.33, P < 0.001] and overall survival (HR 4.21, 95 % CI 1.89–9.37, P < 0.001).

Conclusion

RFA may not be suitable for patients with HCC who have pre-treatment expression of ≥two of these tumor markers.

     

Reduction in amino-acid-induced anti-hypothermic effects during general anesthesia in ovariectomized rats with progesterone replacement

Purpose

The aim of the present study was to determine whether the ovarian hormones, estrogen and progesterone, had different influences on amino-acid-induced anti-hypothermic effects during general anesthesia.

Methods

Ovariectomized Sprague–Dawley female rats were divided into four groups: those administered 17β-estradiol plus saline or an amino acid mixture (E2-Sal and E2-AA, respectively) and progesterone plus saline or an amino acid mixture (P-Sal and P-AA, respectively). Five weeks after ovariectomy, rats were given either E2 or P and then administered either Sal or AA solution for 180 min during anesthesia with sevoflurane. Rectal temperatures were measured.

Results

Rectal temperatures were significantly higher in the E2-AA group than in the E2-Sal group 165 and 180 min after initiating the infusion of the test solutions. However, no significant differences were observed between the P-treated groups. The phosphorylation of 4E-BP1 and S6K1 was significantly greater in the E2-AA group than in the E2-Sal group (P < 0.05, P < 0.001, respectively). In contrast, the phosphorylation of 4E-BP1 was significantly lower in the P-AA group than in the P-Sal group (P < 0.001).

Conclusions

These results suggest that progesterone reduces amino-acid-induced anti-hypothermic effects during general anesthesia.

     

Hip surgery and its evidence base: progress over a decade?

Background

The burden of traumatic and elective hip surgery is set to grow. With an increasing number of techniques and implants against the background of an aging population, the emphasis on evidence-based treatment has never been greater. The purpose of this study was to assess changes in the levels of evidence in the hip literature over a decade.

Materials and methods

Articles pertaining to hip surgery from the years 2000 and 2010 in Hip International, Journal of Arthroplasty, Journal of Bone and Joint Surgery and The Bone and Joint Journal were analysed. Articles were ranked by a five-point level of evidence scale and by type of study, according to guidelines from the Centre for Evidence-based Medicine.

Results

531 articles were analysed from 48 countries. The kappa value for the inter-observer reliability showed excellent agreement between the reviewers for study type (κ = 0.956, P < 0.01) and for levels of evidence (κ = 0.772, P < 0.01). Between 2000 and 2010, the overall percentage of high-level evidence (levels I and II) studies more than doubled (12 to 31 %, P < 0.001). The most frequent study type was therapeutic; the USA and UK were the largest producers of published work in these journals, with contributions from other countries increasing markedly over the decade.

Conclusions

There has been a significant increase in high levels of evidence in hip surgery over a decade (P < 0.001). We recommend that all orthopaedic journals consider implementing compulsory declaration by authors of the level of evidence to help enhance quality of evidence.

Level of evidence

Level 2: economic and decision analysis.

     

Perioperative outcomes and costs of laparoscopic versus open inguinal hernia repair

Purpose

Studies comparing laparoscopic (LIHR) vs. open inguinal hernia repair (OIHR) have shown similar recurrence rates but have disagreed on perioperative outcomes and costs. The aim of this study is to compare laparoscopic vs. open outcomes and costs.

Methods

The National Surgical Quality Improvement Program (NSQIP) was used to compare durations of surgery, anesthesia time, and length of stay (LOS). The University HealthSystem Consortium (UHC) was used to review the cost and complications between approaches. Patients were matched on demographics, year of procedure and surgical approach between datasets for statistical analysis.

Results

A sample of 5468 patients undergoing OIHR (N = 4,693) or LIHR (N = 775) was selected from UHC from 2008–2011. An identical number of patients from NSQIP were matched to those from UHC resulting in a total of 10,936 records. LIHR patients had shorter duration of wait from admission to operation (p < 0.05). Conversely, LIHR patients had longer operating time (p < 0.05), duration of anesthesia (p < 0.05), and time in the operating room (p < 0.05).Overall complication rate was higher in open (3.1 vs. 1.8 %, p < 0.05). Cost favored open over LIHR ($4360 vs $5105). The cost discrepancy mainly stemmed from LIHR supplies ($1448 vs. $340; p < 0.05) and OR services ($1380 vs. $1080; p < 0.05).

Conclusion

This study demonstrates the LOS and perioperative outcomes were superior in the LIHR group; however, the overall cost was higher due to the supplies. Advancement in technology, surgeons’ skill level and preference of supplies are all factors in decreasing the overall cost of LIHR.

     

High Expression of Angiopoietin-1 is Associated with Lymph Node Metastasis and Invasiveness of Papillary Thyroid Carcinoma

Background

We investigated the expression of angiopoietins in patients with papillary thyroid carcinoma (PTC) and the role of angiopoietins as biomarkers predicting the aggressiveness of PTC.

Methods

Expression of angiopoietins was evaluated by immunohistochemistry of tumor specimens from patients with PTC. We demonstrated potential correlations between expression of angiopoietins and clinicopathologic features.

Results

High expression of Ang-1 was positively correlated with a tumor size >1 cm, capsular invasion, extrathyroid extension, lymphovascular invasion, lymph node metastasis, and recurrence (P < 0.05). Moreover, multivariate analysis revealed that high expression of Ang-1 was an independent risk factor for lymph node metastasis (P < 0.001, odds ratio [OR] = 62.113) and lymphovascular invasion (P = 0.027, OR 4.405). However, there was no significant correlation between Ang-2 and clinicopathologic features.

Conclusions

Our results suggest that Ang-1 can serve as a valuable prognostic biomarker for lymph node metastasis and invasiveness in patients with PTC.

     

Risk Factors for Central Neck Lymph Node Metastases in Micro- Versus Macro- Clinically Node Negative Papillary Thyroid Carcinoma

Background

Tumor size has been advocated as possible risk factors for occult central lymph node metastases (CNM) in papillary thyroid carcinoma (PTC) patients. This prospective study evaluated factors that could identify patients at higher risk of occult CNM, especially comparing micro-PTC and macro-PTC.

Methods

One hundred and eighty-six patients were recruited. All the patients had cN0 clinically unifocal PTC and underwent total thyroidectomy and bilateral prophylactic central neck dissection. Risk factors for occult CNM in micro- and macro-PTC patients were evaluated.

Results

Eighty-two patients showed CNM. The rate of CNM did not differ among different sizes cut off (≤20 mm, ≤10 mm, ≤5 mm P = NS). Significantly more pN1a than pN0 patients had pT3 tumors (35/82 vs. 26/104) (P < 0.05), extracapsular invasion (35/82 vs. 22/104) (P < 0.01) and microscopic multifocal disease (50/82 vs. 47/104) (P < 0.05). Independent risk factors for CNM were extracapsular invasion and multifocality at multivariate analysis. Risk factors for CNM in 77 micro-PTC were extracapsular invasion (16/31 pN1 vs. 10/46 pN0, P < 0.05) and multifocality (21/31 pN1 vs. 16/46 pN0, P < 0.01). Among 109 macro-PTC, risk factors for CNM were angioinvasion (15/51 pN1 vs. 7/58 pN0, P < 0.05) and classic PTC at the final histology (PTC vs. tall cell variant vs. follicular variant PTC) (P < 0.05).

Conclusions

Risk factors for CNM can differ between micro- and macro-PTC, but no preoperatively known clinical parameter is predictor of CNM in cN0 clinically unifocal PTC.

     

Risk factors for surgical site infection after posterior fixation surgery and intraoperative radiotherapy for spinal metastases

Purpose

Posterior surgery with intraoperative radiotherapy for spinal metastases offers effective therapy, as we have reported previously. However, the procedure involves transfer from the operating room to the radiotherapy room, and as these patients are somewhat immunocompromised, the risk of postoperative surgical site infection (SSI) may be increased. The aim of our study was to identify risk factors and patient characteristics associated with postoperative SSI following posterior fixation surgery and intraoperative radiotherapy for spinal metastases.

Methods

Participants comprised 279 patients who underwent IORT for the treatment of spinal metastases between August 2004 and June 2013. Patients who suffered SSI within 1 month after surgery were categorized as infected, and all others were categorized as non-infected. We compared factors of age, sex, use of pre-operative corticosteroid, medical history of diabetes, prognosis scores (Tomita, Tokuhashi, and Katagiri), pre- and postoperative Frankel scale scores, site of tumor origin, administration of pre-operative radiotherapy, operation time, intraoperative blood loss, intraoperative irradiation dose, and pre- and postoperative performance status between groups.

Results

SSI occurred in 41 patients (14.7 %). Katagiri’s and Tokuhashi’s prognostic scores (P < 0.05 each), postoperative Frankel scale score (P < 0.01), administration of pre-operative radiotherapy (P < 0.05), and postoperative performance status (P < 0.05) all correlated significantly with occurrence of SSI. Multivariate analysis using those factors revealed administration of pre-operative radiotherapy as a factor independently associated with SSI (P < 0.05).

Conclusions

Patient prognosis, postoperative ambulatory function, and pre-operative radiotherapy were risk factors for SSI in patients with spinal metastases. Duration of surgery and intraoperative blood loss were not associated with occurrence of SSI.

     

Clinical and microbiological outcomes in haematogenous spondylodiscitis treated conservatively

Introduction

Spondylodiscitis refers to infections of the intervertebral disc and the adjacent vertebral body. Although it is still considered a rare condition, its rate is projected to increase. Mortality rate is considered to be low, but an estimated one third of the survivors experience residual disabilities. Literature shows that uncomplicated spondylodiscitis can be adequately treated by early antibiotic therapy and immobilization. The aim of the study is to evaluate the outcome of conservative treatment in patients with haematogenous spondylodiscitis.

Materials and methods

All patients with haematogenous spondylodiscitis observed in two orthopaedic centres were retrospectively considered. The medical records, radiologic imaging, bacteriology results, treatment, and complications of all patients were reviewed.

Results

Thirty patients (median age 64 years, range 15–77, females 56.7%) were considered in the study, eight (26.7%) showed residual back pain at median follow-up of 117 weeks (range 104–189). A significant difference in SF-36 physical (P < 0.001), SF-36 mental function (P < 0.002), and Oswestry Disability Index (ODI) (P < 0.001) scores was observed among patients with residual local pain compared to the ones who had not. Methicillin-resistant Staphylococcus aureus (MRSA) infection and symptoms duration before the diagnosis were associated with an increased risk of persistent back pain and permanent disability. The most important negative determinants of SF-36 mental function were the age of patients (ρ = 0.36, P < 0.05), the duration of symptoms before the diagnosis (ρ = 0.44, P < 0.05) and MRSA infection (P = 0.006). Spondylodiscitis sustained by MRSA and the duration of symptoms before the diagnosis influenced negatively the physical status (P = 0.002) and ODI (ρ = 0.36, P < 0.05), respectively.

Conclusions

Conservative approaches are safe and effective for patients without complications. A delayed diagnosis and MRSA infections are related to poor clinical outcome among patients treated by conservative treatment; this must be carried out scrupulously with close patient monitoring.

     

Elevated plasma aldosterone is an independent risk factor for erectile dysfunction in men

Introduction

Erectile dysfunction (ED) and cardiovascular disease (CVD) share a great number of common risk factors. There is growing evidence that aldosterone, an independent CVD risk factor, is associated with ED.

Aims

The purpose of this study was to determine the relationship between plasma aldosterone and erectile dysfunction.

Methods

This study recruited 287 participants, ranging from 18 to 84 years old; 217 were suffering from ED, diagnosed by the International Index of Erectile Function 5 (IIEF-5) scores. Based on IIEF-5 scores, patients were divided into one control group and three ED groups (mild ED; moderate ED; severe ED).

Main outcome measures

The differences in principal characteristics, blood routine, sexual hormone, adrenal hormone, thyroid hormone, renal function, liver function and blood lipid were compared between ED and control groups.

Results

Our study demonstrated that the difference of mean plasma aldosterone levels between ED group and the control group was statistically significant (P < 0.05). Stepwise logistic regression analysis of all the possible factors support the role of aldosterone as an independent risk factor for ED (OR 1.011; 95 % CI 1.003–1.018; P = 0.004). Similar statistical methods were applied to the comparison between moderate to severe ED group and control to mild ED group (OR 1.017; 95 % CI 1.009–1.024; P < 0.001). ROC curve and the area under the curve (0.718; 95 % CI 0.643–0.794; P < 0.001) were performed to assess the diagnostic effect and to compare the severity of risk with the known independent risk factors, such as age and cholesterol (0.704; 95 % CI 0.631–0.778; P < 0.001). When using a 374 pg/mL cut-off value from Youden index, the OR of ED group versus controls is 3.106 (95 % CI 1.458–6.617), while the OR of moderate to severe ED versus control and mild ED is 5.480 (95 % CI 3.108–9.662).

Conclusions

We determined that elevated plasma aldosterone concentration is an independent risk factor for ED. Our findings also indicate that the aldosterone, a well-recognized contributor to vascular injury, might be a potential bond between ED and CVD.

     

A validated preoperative score predicting survival and functional outcome in lung cancer patients operated with posterior decompression and stabilization for metastatic spinal cord compression

Purpose

This study aims to create and validate a score for survival and functional outcome of lung cancer patients with metastatic spinal cord compression (MSCC) after posterior decompressive surgery.

Methods

The entire cohort of 73 consecutive patients was randomly assigned to a test group (N = 37) and a validation group (N = 36). In the test group, we retrospectively analyzed 10 preoperative characteristics. Characteristics significantly associated with survival on multivariate analysis were included in the score. Patients in the validation group were used to confirm whether the score was reproducible. Postoperative functional outcome was analyzed both in the test and validation groups.

Results

On multivariate analysis, preoperative ambulatory status (P = 0.0017), visceral metastases (P = 0.0002), and time developing motor deficits (P = 0.0004) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 0 to 6 points, two risk groups were designed: 0–2 and 3–6 points and the median survival was 2.6 months (95 % CI, 1.0–3.8 months) and 10.7 months (95 % CI, 7.1–13.7 months), respectively (P < 0.0001). In the validation group, the corresponding median survival was 2.7 months (95 % CI, 1.6–5.5 months) and 10.8 months (5.8–13.6 months), respectively (P < 0.0001). In addition, the functional outcome was worse in patients with 0–2 points than in patients with 3–6 points both in the test (P = 0.0023) and validation groups (P = 0.0298).

Conclusion

Patients with scores of 0–2 points, who have short survival time (life expectancy less than 3 months) and poor functional outcome, appear best treated with radiotherapy or best supportive care alone. Surgery may be no longer in consideration in most of the patients in this group. Patients with score of 3–6 points should be surgical candidates, because survival prognosis (life expectancy more than 10 months) and functional outcome are favorable after surgery.

     

Acute Appendicitis During Pregnancy: Different from the Nonpregnant State?

Background

Acute appendicitis is the most common nonobstetric indication for surgical intervention during pregnancy. However, the current literature is scarce and composed of relatively small case series. We aimed to compare the presentation, management, and surgical outcomes of presumed acute appendicitis between a contemporary cohort of pregnant women and nonpregnant women of reproductive age.

Methods

The study group included 92 pregnant patients who underwent appendectomy for presumed acute appendicitis at a single tertiary medical center in 2000–2014. Preoperative, operative, and postoperative clinical data were derived from medical records and compared to data for 494 nonpregnant patients of reproductive age who underwent appendectomy in 2004–2007 at the same institution.

Results

Median age was 28 years (range 25–33) in the study group and 26 years (range 20–34) in the control group (P = 0.1). There were no between-group differences in mean white blood cell count, patient interval, hospital interval, or operative time. Preoperative abdominal ultrasound was used in a significantly higher proportion of patients in the pregnant group than in the nonpregnant group (73 and 27 %, respectively, P < 0.001) and computed tomography, in a significantly lower proportion of patients (1 vs. 16 %, respectively, P < 0.001) . The two groups had similar rates of negative appendectomy (23 and 22 %, P = 0.9), complicated appendicitis (12 and 11 %, P = 0.9), and overall postoperative complications (15 and 12 %, P = 0.3).

Conclusions

The clinical presentation and outcome of presumed acute appendicitis are similar in pregnant women and nonpregnant women of reproductive age. Therefore, similar perioperative management algorithms may be applied in both patient populations.

     

Prognostic role of decreased E-cadherin expression in patients with upper tract urothelial carcinoma: a multi-institutional study

Purpose

To assess the role of E-cadherin as prognostic biomarker in upper tract urothelial carcinoma (UTUC) in a large multi-institutional cohort of patients.

Methods

Immunohistochemistry technique was used to evaluate E-cadherin expression in 678 patients with unilateral, sporadic UTUC treated with RNU. E-cadherin expression was considered decreased if 10 % or more cells had decreased expression (<90 %).

Results

Decreased E-cadherin expression was observed in 353 patients (52.1 %) and was associated with advanced pathological stage (P < 0.001), higher grade (P < 0.001), lymph node metastasis (P = 0.006), lymphovascular invasion (P < 0.001), concomitant carcinoma in situ (P < 0.001), multifocality (P = 0.004), tumor necrosis (P = 0.020) and sessile architecture (P < 0.001). Within a median follow-up of 30 months (interquartile range 15–57), 171 patients (25.4 %) experienced disease recurrence and 150 (21.9 %) died from UTUC. In univariable analyses, decreased E-cadherin expression was significantly associated with worse recurrence-free survival (P < 0.001) and cancer-specific survival CSS (P = 0.006); however, in multivariable analyses, it was not (P = 0.74 and 0.84, respectively). The lack of independent prognostic value of E-cadherin remained true in all subgroup analyses.

Conclusion

In UTUC patients treated with RNU, decreased E-cadherin expression is associated with features of biologically and clinically aggressive disease and worse outcome in univariable, but not multivariable, analyses. If E-cadherin’s association with factors of advanced disease is confirmed on UTUC biopsy specimens, it could be used to help in the clinical decision-making regarding kidney-sparing approaches and/or neo-adjuvant chemotherapy.

     

Is reduction better than arthrodesis in situ in surgical management of low-grade spondylolisthesis? A system review and meta analysis

Purpose

To compare the clinical and radiographic outcomes of arthrodesis in situ with arthrodesis after reduction in low-grade spondylolisthesis.

Methods

We performed a comprehensive search of both observational and randomized clinical trials published up to April 2016 in PubMed, MEDLINE, Cochrane Library, and Embase databases. The outcomes included age, sex, operative time, blood loss, and at least 2 years clinical results of Oswestry disability index (ODI), visual analogue scale (VAS), lumbar lordosis, slippage, fusion rate, the rate of good and excellent and the complication rate. Two authors independently extracted the articles and the predefined data.

Results

Seven eligible studies, involving four RCTs and three cohort studies were included in this systematic review and meta-analysis. Patients who underwent reduction did achieved better slippage correction comparing with arthrodesis in situ (P < 0.00001). However, there was no significant difference in the case of operative time, blood loss, VAS (P = 0.36), ODI (P = 0.50), lumbar lordosis (P = 0.47), the rate of good and excellent (P = 0.84), fusion rate (P = 0.083) and complication rate (P = 0.33) between the arthrodesis in situ group and the reduction group.

Conclusions

On the basis on this review, arthrodesis after reduction of low-grade spondylolisthesis potentially reduced vertebral slippage. Reduction was neither associated with a longer operative time nor more blood loss. There was no significant difference in the outcomes between reduction and arthrodesis in situ group. Both procedures could be expected to achieve good clinical result.

Level of evidence

Therapeutic Level IIa.

     

Impact of artificial capnothorax on coagulation in patients during video-assisted thoracoscopic esophagectomy for squamous cell carcinoma

Background

Compared with the lung isolation using double-lumen endobronchial tube intubation, the artificial capnothorax using single-lumen endotracheal tube intubation has shown to be a safe, more convenient, and cost-effective procedure for thoracoscopic esophagectomy. However, the impact of capnothorax on coagulation is not well defined. Herein, we evaluate the impact of a capnothorax on coagulation and fibrinolysis in patients who undergoing thoracoscopic esophagectomy.

Methods

Between March 2014 and August 2014, 24 patients underwent thoracoscopic esophagectomies for esophageal cancer with the procedure of artificial capnothorax (group P); we also performed 24 thoracoscopic esophagectomy cases without using capnothorax (group N). The demographics and arterial blood gas, as well as the parameters of coagulation and fibrinolysis, of the two groups were analyzed.

Results

The pH value of group P after CO₂ insufflation was significantly lower than in group N (P < 0.05), and the partial pressure of carbon dioxide (PaCO₂) was significantly increased compared with group N (P < 0.05). The R and K values after CO₂ insufflation were significantly longer than before anesthesia (P < 0.05), and both α angle and MA value after CO₂ insufflation were significantly lower than those before anesthesia (P < 0.05). No significant differences in R value, K value, α angle, or MA value were observed between pre-anesthesia and termination of capnothorax. No significant difference in LY30 data was found between different groups (P > 0.05).

Conclusion

Artificial capnothorax in patients receiving endoscopic resection of esophageal carcinoma had a significant impact on coagulation. These patients showed significant impairments in coagulation not observed in patients without artificial capnothorax.