Comparative evaluation of clinical and inflammatory factors in response to the pharmacological managements in metabolic syndrome

Our study focused to assess the effect of various potential treatments on components of metabolic syndrome (MetS). This is a prospective, open-label, parallel group and randomized control trial of 90-day duration in which patients (n = 159) were randomly assigned in four groups to receive “diet and lifestyle modification” (n = 40), “metformin 500 mg twice daily” (n = 39), “pioglitazone 15 mg once daily” (n = 39), and “rosuvastatin 10 mg once daily” (n = 41). Clinical, biochemical, and inflammatory markers of each participant were evaluated. Fasting plasma glucose (FPG) level was lower in all except rosuvastatin group while HDL-cholesterol level increased in rosuvastatin group only (p < 0.05). Serum triglyceride was significantly and comparably decreased in both pioglitazone and rosuvastatin group (p < 0.05). Significant decrease in hsCRP and increase in serum adiponectin (p < 0.05) were reported in all the groups from baseline. The study can add a step forward in devising standard pharmacotherapeutic regimen beyond the current treatment modalities.     

Curative versus palliative treatments for recurrent hepatocellular carcinoma: a multicentric weighted comparison

BackgroundManagement of recurrence after surgery for hepatocellular carcinoma (rHCC) is still a debate. The aim was to compare the Survival after Recurrence (SAR) of curative (surgery or thermoablation) versus palliative (TACE or Sorafenib) treatments for patients with rHCC.MethodsThis is a multicentric Italian study, which collected data between 2007 and 2018 from 16 centers. Selected patients were then divided according to treatment allocation in Curative (CUR) or Palliative (PAL) Group. Inverse Probability Weighting (IPW) was used to weight the groups.Results1,560 patients were evaluated, of which 421 experienced recurrence and were then eligible: 156 in CUR group and 256 in PAL group. Tumor burden and liver function were weighted by IPW, and two pseudo-population were obtained (CUR = 397.5 and PAL = 415.38). SAR rates at 1, 3 and 5 years were respectively 98.3%, 76.7%, 63.8% for CUR and 91.7%, 64.2% and 48.9% for PAL (p = 0.007). Median DFS was 43 months (95%CI = 32-74) for CUR group, while it was 23 months (95%CI = 18-27) for PAL (p = 0.017). Being treated by palliative approach (HR = 1.75; 95%CI = 1.14–2.67; p = 0.01) and having a median size of the recurrent nodule>5 cm (HR = 1.875; 95%CI = 1.22–2.86; p = 0.004) were the only predictors of mortality after recurrence, while time to recurrence was the only protective factor (HR = 0.616; 95%CI = 0.54–0.69; p<0.001).ConclusionCurative approaches may guarantee long-term survival in case of recurrence.     

The technical approach to laparoscopic colectomy in patients who have undergone prior abdominoplasty

Background

For those patients undergoing laparoscopic colorectal surgery who have had prior abdominoplasty, cosmetic outcome is important and the technical considerations for laparoscopy in post-abdominoplasty patients have not been previously addressed. The aim of the present study was to define the technical approach to the post-abdominoplasty patient undergoing laparoscopic colorectal surgery after abdominoplasty.

Methods

Utilizing the technical approach described, eleven patients underwent laparoscopy after prior abdominoplasty over a 7-year period.

Results

The majority of patients (10/11) felt their laparoscopic colorectal resection had no adverse effect on the aesthetics of their prior abdominoplasty. From a surgeon’s standpoint, the only significant challenge was due to the loss of abdominal wall compliance.

Conclusions

The surgical approach to laparoscopic colectomy in the post-abdominoplasty patient requires careful planning. Cosmetic outcome is a particularly important consideration for this subset of patients, and this should be appreciated by the operating surgeon.     

Contrast echocardiography accurately predicts myocardial perfusion before angiography during acute myocardial infarction

OBJECTIVES: To determine whether myocardial contrast echocardiography (MCE) can quickly and accurately assess myocardial perfusion and infarct-related artery (IRA) patency before emergency angiography during acute myocardial infarction (AMI). BACKGROUND: Despite encouraging experimental and clinical studies, the reliability and practicality of MCE in predicting IRA patency during AMI before angiography has not been proven. METHODS: Two-dimensional echocardiography and MCE were performed in 51 patients with AMI just before emergency angiography. With knowledge of the electrocardiogram findings and regional wall motion, myocardial perfusion was assessed to predict IRA patency. RESULTS: Myocardial perfusion studies were adequate for interpretation in 40 patients. An occluded IRA was predicted in 28 patients; the artery was occluded in 22 patients, and six patients had Thrombolysis In Myocardial Infarction (TIMI) grade 2 flow or less. A patent IRA was predicted in 12 patients; eight patients had TIMI grade 3 flow, one patient had TIMI grade 2 flow and the IRA was occluded in three patients. In one of the three patients, the appropriate view was not obtained. In another patient, collateral flow was adequate for near-normal regional wall motion, and in the last, the findings suggested reperfusion of the proximal artery with distal embolic occlusion. Taken together, MCE accurately predicted either TIMI grade 2 flow or less, or TIMI grade 3 flow in 36 of 40 patients. Sensitivity was 87.5%, specificity and positive predictive value were 100% and negative predictive power was 66.7% (P<0.001). CONCLUSIONS: MCE, together with the electrocardiogram and regional wall motion, can be used to quickly and reliably predict IRA patency early during AMI and may be useful to facilitate a management strategy.     

Restrictive impairment in patients with asthma

BACKGROUND: Patients with asthma have intermittent or persistent airflow obstruction, most often manifested spirometrically by reduced forced expiratory volume in 1s (FEV(1)) and FEV(1)/vital capacity (VC) ratio. In some patients, the VC may be reduced by air trapping, with an increase in functional residual capacity (FRC) and residual volume (RV) (pseudorestriction). We have reported 12 asthmatic patients with reduced VC and no increase in RV, i.e., a true restrictive impairment [Gill et al. True restrictive impairment in bronchial asthma. Am J Respir Crit Care Med 1999:159:A652]. OBJECTIVES: To confirm previous observations of true restrictive impairment (not attributable to air trapping) in patients with asthma, and to estimate its frequency in an asthmatic population. METHODS: Review of pulmonary function tests and clinical records of all post-pubertal patients diagnosed as asthma between January 2000 and September 2003 in a 184 bed inner city teaching hospital in Jamaica, Queens, New York. The clinical diagnosis of asthma was accepted when one or more of the following pulmonary function criteria were met: Positive bronchodilator response (BD), positive methacholine, repeated variability in spirometric values. Restriction was defined as decrease in total lung capacity (TLC) or decrease in VC with no increase in functional residual capacity (FRC) plus normal or high FEV(1)/FVC ratio. Patients with any clinical finding consistent with restriction, including a decreased diffusing capacity (DL) or obesity (BMI >30) were excluded. RESULTS: A total of 100 of 413 (24%) patients with asthma had restriction; 21 of these met all exclusions (including DL and BMI) and 11 (of 46) patients with an increased BMI and normal DL normalized their FVC on BD therapy, demonstrating that their pre-BD restrictive impairment could not be attributed to obesity. Plethysmographic FRC was measured in 81 of the 100 patients with restriction and was increased in only seven. CONCLUSION: True restrictive impairment was noted in at least 32 of 413 asthmatics (8%), consistent with previous observations in asthma and reactive airways dysfunction syndrome. This finding is not widely recognized and should not preclude the diagnosis of asthma, BD testing or appropriate therapy for asthma.