Laparoscopic Colectomy Decreases the Time to Administration of Chemotherapy Compared with Open Colectomy

Background

Minimally invasive colon surgery (MIS) has been shown to minimize pain and decrease overall recovery time. No studies have shown a clear oncologic benefit. Some literature suggests that the time to administration of chemotherapy can be important to improve outcomes for advanced colon cancer. The goal of this study is to evaluate the effect of minimally invasive surgery on the timing of chemotherapy administration.

Methods

This was a retrospective review of all patients undergoing surgery for colon cancer at a tertiary institution between 2004 and 2013.

Results

A total of 668 partial colectomies for cancer were performed; 241 were stage III and above and deemed appropriate for chemotherapy. Eighty-five patients did not receive chemotherapy (patient’s wishes, age/comorbidities or lost to follow-up). Of the 156 patients who received chemotherapy, 57 underwent MIS and 99 had open colectomy. Average time to chemotherapy after MIS colectomy was 42.9 versus 60.3 days for open surgery (p < 0.001). In the open group, 52 (53 %) people had postoperative complications and readmissions versus 24 (39 %) in the MIS group. Postoperative complications increased the time to chemotherapy for all patients. However, among patients with complications, patients in the MIS group were still able to start chemotherapy earlier (p < 0.05) than open colectomy patients. Multivariate analysis revealed the MIS approach as the only factor lowering time between surgery and chemotherapy.

Conclusions

Laparoscopic colectomy decreases the time interval from surgery to the start of chemotherapy compared with open colectomy. Postoperative complications increase the time to chemotherapy for both open and MIS surgery.     

Retreatment of patients with chronic hepatitis C,subtype 1b and cirrhosis,who failed previous direct‐acting antiviral therapy including first‐ and second‐generation NS5A inhibitors with ombitasvir/paritaprevir/ritonavir,dasabuvir + sofosbuvir + ribavirin

The use of direct‐acting antiviral agents (DAAs) in patients with chronic HCV genotype 1 infection results in sustained virologic response (SVR) rates of 95%‐97%, but 3%‐5% of patients experience virologic failure. We observed 17 patients infected with HCV subtype 1b who failed previous treatment with DAA, including 13 subjects (76.5%) with liver cirrhosis. Twelve subjects (70.6%) previously received NS5A inhibitors of the first generation (ledipasvir or daclatasvir) and five subjects (29.4%) – the second generation (velpatasvir). All patients were retreated with a combination of ombitasvir/paritaprevir/ritonavir and dasabuvir (3D) with sofosbuvir (SOF) and ribavirin (RBV). We compared SVR₁₂ rates depending on fibrosis stage, presence of just single or double NS5A mutations (L31M/V/I and/or Y93H), and on the generation of previously used NS5A inhibitor. Observed SVR₁₂ rates were as follows: 94.1% (16/17 patients) overall; 100% in patients without cirrhosis (n = 4) vs 92.3% in those with cirrhosis (n = 13); 100% with single L31M/V/I or Y93H mutation (n = 7) vs 88.9% with double mutations (n = 9); 100% in patients who previously failed first generation (n = 12) vs 80.0% in those failed second‐generation NS5A inhibitors (n = 5). Retreatment with 3D + 0SOF + RBV was highly effective and safe in patients with chronic HCV GT1b infection who failed previous use of NS5A inhibitors. Fibrosis stage, baseline presence of NS5A RAS mutations and the generation of previously used NS5A inhibitors may impact the probability of achieving SVR₁₂, but statistical significance was not demonstrated in our small retrospective cohort. Further studies in a larger population are needed to confirm or not the predictive value of these baseline factors.     

Application of the LPE-Grown LuAG: Ce Film/YAG Crystal Composite Thermoluminescence Detector for Distinguishing the Components of the Mixed Radiation Field

Single-crystalline films (SCFs) of the LuAG: Ce garnet grown using the liquid-phase epitaxy method onto YAG single-crystal (SC) substrates were investigated for possible applications as composite thermoluminescent (TL) detectors. Such detectors may help to register the different components of ionizing radiation fields with various penetration depths, e.g., heavy charged particles and gamma or beta rays. It was found that the TL signal of LuAG: Ce SCF sufficiently differs from that of the YAG substrate concerning both the temperature and wavelength of emissions. Furthermore, even by analyzing TL glow curves, it was possible to distinguish the difference between weakly and deeply penetrating types of radiation. Within a test involving the exposure of detectors with the mixed alpha/beta radiations, the doses of both components were determined with an accuracy of a few percent.     

Efficacy of Tocilizumab Therapy in Different Subtypes of COVID-19 Cytokine Storm Syndrome

Background: Cytokine storm in COVID-19 is heterogenous. There are at least three subtypes: cytokine release syndrome (CRS), macrophage activation syndrome (MAS), and sepsis. Methods: A retrospective study comprising 276 patients with SARS-CoV-2 pneumonia. All patients were tested for ferritin, interleukin-6, D-Dimer, fibrinogen, calcitonin, and C-reactive protein. According to the diagnostic criteria, three groups of patients with different subtypes of cytokine storm syndrome were identified: MAS, CRS or sepsis. In the MAS and CRS groups, treatment results were assessed depending on whether or not tocilizumab was used. Results: MAS was diagnosed in 9.1% of the patients examined, CRS in 81.8%, and sepsis in 9.1%. Median serum ferritin in patients with MAS was significantly higher (5894 vs. 984 vs. 957 ng/mL, p < 0.001) than in those with CRS or sepsis. Hypofibrinogenemia and pancytopenia were also observed in MAS patients. In CRS patients, a higher mortality rate was observed among those who received tocilizumab, 21 vs. 10 patients (p = 0.043), RR = 2.1 (95% CI 1.0–4.3). In MAS patients, tocilizumab decreased the mortality, 13 vs. 6 patients (p = 0.013), RR = 0.50 (95% CI 0.25–0.99). Conclusions: Tocilizumab therapy in patients with COVID-19 and CRS was associated with increased mortality, while in MAS patients, it contributed to reduced mortality.     

Use of phased array coils for a determination of absolute metabolite concentrations.

This work describes the use of phased array coils for a quantification of absolute metabolite concentrations. The method is demonstrated for single-voxel localized proton MRS of human brain with an eight-element receive-only head coil. It is based on the transmitter reference amplitude of the body coil used for RF transmission. A relative sensitivity of every element of the phased array coil is derived from a combination of two reference scans without water suppression that correspond to either the body coil in transmit-receive mode or the phased array coil in conjunction with body coil excitation. Experimental results were obtained at 2.9 T for both phantoms and 12 human subjects in different locations of gray and white matter. The data demonstrate that the procedure is technically robust and without a penalty in measuring time. Moreover, it takes full advantage of the signal-to-noise gain for quantitative proton MRS and may be extended to other phased array coils without the need for a recalibration.     

Cortical Catecholamine Secretion Following Intravenous Nitroprusside Infusion: A Voltammetric Study

Intravenous administration of sodium nitroprusside (NP) decreases blood pressure and activates noradrenergic neurons in the locus coeruleus (LC). Microdialysis studies have shown that NP infusion is accompanied by increased extracellular concentrations of norepinephrine (NE) in the medial prefrontal cortex. The present study used in vivo voltammetry to obtain a finer temporal analysis of the NP-induced changes in the extracellular concentrations of catecholamine-like compounds in the LC terminal fields in the rat medial prefrontal cortex. Intravenous infusion of rats with NP caused a rapid decrease in blood pressure that lasted for the duration of the infusion but rapidly reversed when the infusion was terminated. After a delay of between about 2 and 8 min (mean 5 min), there was an increase in extracellular concentrations of a NE-like substance. Presumed cortical release of NE lasted for several minutes but had almost returned to baseline by the time the NP infusion was terminated at 15 min. In many cases, the first peak was followed by a second one, usually of smaller amplitude but more prolonged than the first one. There was no clear response to the cessation of infusion of NP. The time course of the initial response is comparable to the previously reported electrophysiological response of LC-NE neurons to NP. In rats treated with DSP-4 to deplete cortical NE, blood pressure was reduced as in untreated rats, but no voltammetric response to NP infusion was observed. These results suggest that activation of the NE-LC neurons by NP results in a delayed synaptic release of NE in the cerebral cortex which attenuates within several minutes.     

Prediction of mortality in severely injured patients with facial bone fractures

Purpose

Identify the most common concomitant injuries associated with facial trauma, and compare the efficacy of various scoring systems in estimation of mortality risks in this category of patients.

Methods

The study evaluated patients with facial and concomitant injuries, who received the multidisciplinary treatment in a specialized trauma hospital. Values of New Injury Severity Score, Glasgow Coma Scale, Facial Injury Severity Scale, age, and length of hospital stay were statistically analysed to determine presence of relationships between these indicators and define factors that significantly associated with lethal outcome.

Results

During 6-year observation period, 719 patients were treated with multiple or combined maxillofacial trauma, brain injuries and polytrauma. Mainly with isolated midface bones (49.7%), pan-facial (34.6%), mandible (12.9%), and frontal bone and walls (2.8%) fractures. Mortality was (2.2%). The mortality rates in patients with severe pan-facial fractures were higher (p?=?0.008) than in single anatomical area (6% vs 1.5%). Age, GCS, and NISS were the most reliable indicator of lethal outcome.

Conclusion

Age, Glasgow Coma Scale and New Injury Severity Score main factors, that predicts lethal outcome with high accuracy. New Injury Severity Score value?≥?41 is a critical level for survival prognosis and should be considered in treatment planning and management of this category of patients.

     

Effect of sleep on overnight cerebrospinal fluid amyloid β kinetics

Sleep disturbances are associated with future risk of Alzheimer disease. Disrupted sleep increases soluble amyloid β, suggesting a mechanism for sleep disturbances to increase Alzheimer disease risk. We tested this response in humans using indwelling lumbar catheters to serially sample cerebrospinal fluid while participants were sleep‐deprived, treated with sodium oxybate, or allowed to sleep normally. All participants were infused with ¹³C₆‐leucine to measure amyloid β kinetics. We found that sleep deprivation increased overnight amyloid β38, amyloid β40, and amyloid β42 levels by 25 to 30% via increased overnight amyloid β production relative to sleeping controls. These findings suggest that disrupted sleep increases Alzheimer disease risk via increased amyloid β production. Ann Neurol 2018;83:197–204