Effectiveness and safety of outpatient pleurodesis in patients with recurrent malignant pleural effusion and low performance status

OBJECTIVES:

To evaluate the effectiveness and safety of pleurodesis carried out entirely on an outpatient basis in patients with recurrent malignant pleural effusions and Karnofsky Performance Status scores ≤70.

METHODS:

This study was a prospective trial comprising patients with symptomatic recurrent malignant pleural effusion and Karnofsky Performance Status scores ≤70 but >30. All selected patients underwent pleural catheter placement (14 Fr) in an outpatient facility. When chest radiography revealed post‐drainage lung expansion of >90%, pleurodesis (3 g of talc) was performed. Catheters were maintained until the daily output was <100 mL/day. The patients were evaluated in the first month and every three months thereafter for fluid recurrence, the need for additional procedures, and complications.

RESULTS:

During the study period (January 2005 to July 2007), 64 patients (24 men, 40 women), with an average age of 61.4 years, underwent elective chest tube drainage. Primary sites of the underlying malignancy were breast (27), lung (22), and others (15). Sixty‐six pleural catheters were placed (bilaterally in 2 patients), and 52 talc pleurodesis procedures were performed. Fourteen patients had a trapped lung and were excluded from the trial. No complications were observed during catheter placement or pleurodesis. Post‐pleurodesis complications included catheter obstruction (4 patients) and empyema (1). The average drainage time was 9.9 days. The recurrence rate observed in patients that were alive 30 days after pleurodesis was 13.9% (5/36 patients). Six patients required additional procedures after the pleurodesis. The average survival time was 101 days.

CONCLUSION:

In this study, talc pleurodesis was safely performed in an outpatient setting with good efficacy and a reasonable complication rate, thereby avoiding hospital admission.     

Clinical correlates of JAK2V617F allele burden in essential thrombocythemia

BACKGROUND: JAK2V617F occurs in approximately 50% of patients with essential thrombocythemia (ET). Qualitative studies of mutation analysis have previously reported an association between JAK2V617F and advanced age, higher hemoglobin level, higher leukocyte count, and lower platelet count. A possible association with thrombotic complication has also been considered. METHODS: Allele-specific, quantitative polymerase chain reaction (PCR) analysis for JAK2V617F was performed in 176 patients with ET using genomic DNA from archived bone marrow, which was collected within 1 year (n=72 patients), between 1 and 5 years (n=64 patients), or after 5 years (n=40 patients) of diagnosis. RESULTS: JAK2V617F was detected in 96 patients (55%), in whom mutant allele burden ranged from 1% to 100% (median, 6.3%). Neither mutational frequency (P=.37) nor mutant allele burden (P=.62) was affected by the timing of bone marrow sample collection. The presence of JAK2V617F was found to be significantly associated with higher hemoglobin level (P<.0001), lower platelet count (P=.001), higher leukocyte count (P=.008), increased incidence of venous thrombosis occurring after diagnosis (P=.02), and older age at diagnosis (P=.03). All but age retained significance in multivariable analysis. In mutation-positive patients (n=96 patients), JAK2V617F allele burden clustered between 1% and 22% in 94 cases, in whom it correlated directly and significantly with platelet and leukocyte counts, palpable splenomegaly at diagnosis, and venous thrombosis occurring after diagnosis. The latter 2 associations remained significant with the inclusion of the remaining 2 outlier cases with 100% mutant allele burden; in addition, an association with male gender became evident. CONCLUSIONS: JAK2V617F allele burden imparts additional phenotypic effects in ET.     

Functional changes after physiotherapy in fecal incontinence

Background Physiotherapy is a common treatment option in patients with fecal incontinence. Although physiotherapy may result in relief of symptoms, to what extent improvement is associated with changes in anorectal function is still unclear.Aim The aim of the present study was to investigate prospectively how anorectal function changes with physiotherapy and whether these changes are related to changes in fecal incontinence score.Methods Consenting consecutive patients (n=266) with fecal incontinence (91% women; mean age, 59 years) underwent anorectal manometry, anal and rectal mucosal sensitivity measurements, and rectal capacity measurement at baseline and after nine sessions of standardized pelvic floor physiotherapy. These findings were compared with changes in Vaizey incontinence score.Results On follow-up 3 months after physiotherapy, squeeze pressure (p=0.028), as well as urge sensation threshold (p=0.046) and maximum tolerable volume (p=0.018), had increased significantly. The extent of improvement was not related to age, duration of fecal incontinence, menopause, and endosonography findings. All other anorectal functions did not change. An improvement in the Vaizey score was moderately correlated with an increase in incremental squeeze pressure (r=0.14, p=0.04) and a decrease in anal mucosal sensitivity threshold (r=0.20, p=0.01).Conclusions Physiotherapy improves squeeze pressure, urge sensation, and maximum tolerable volume. However, improved anorectal function does not always result in a decrease in fecal incontinence complaints.     

Intestinal Morphometric Changes Induced by a Western-Style Diet in Wistar Rats and GSPE Counter-Regulatory Effect

Western-style diet is an obesogenic diet for rodents and humans due to its content of saturated fat and refined sugars, mainly sucrose and, in consequence, sucrose-derived fructose. This type of diets relates with intestinal disturbances when consumed regularly. The aim of this work was to analyse the adaptive morphologic and functional changes at intestinal level derived from the unhealthy components of a Cafeteria diet in rats. The effect of grape seed proanthocyanidin extract (GSPE) in the prevention of diet-induced intestinal dysfunction was also analysed. Rats were fed a 17-week cafeteria diet (CAF) without or with oral-GSPE supplementation, either intermittent GSPE administration (SIT-CAF); last 10-day GSPE supplementation at doses of 100 mg/kg and 500 mg/kg day (CORR-100) and (CORR-500) or pre-supplementation with 500 mg/kg GSPE (PRE-CAF). GSPE-CAF supplemented groups showed similar results to CAF diet group regarding morphology and inflammatory score in the duodenum. As an adaptive response to diet, CAF increased intestinal absorptive surface (1.24-fold) all along the intestinal tract and specifically in the small intestine, duodenum, due to increase villus height and a higher villus/crypt ratio, in addition to increase in Goblet cell percentage and inflammatory index. Animals fed GSPE at the current doses and times had higher villus heights and absorptive surface similar to Cafeteria diet group. In the duodenum, villus height correlated with body weight at 17 week and negatively with MLCK gene expression. In the colon, villus height correlated with the percentage of goblet cells. In conclusion, the CAF diet produced adaptive modifications of the intestine by increasing the absorptive area of the small intestine, the percentage of goblet cells and the inflammatory index at the duodenal level. GSPE supplementation can partially reverse the intestinal morphological changes induced by the high fat/sucrose diet when administered intermittently.     

Effect of an experimental desensitizing gel on bleaching-induced tooth sensitivity after in-office bleaching—a double-blind,randomized controlled trial

Clinical Oral Investigations - To evaluate the risk and intensity of tooth sensitivity (TS), and the efficacy of in-office bleaching after applying an experimental desensitizing gel composed of 10%...     

Impact of COVID-19 on abdominal organ transplantation: A bibliometric analysis

Background

Abdominal solid organ transplant (SOT) programs have been hit hard by the COVID-19 pandemic, which was officially declared as such on March 11, 2020. Over two years, the tightening and softening of limitations in response to the “waves” of infection and COVID-19 fluctuations have provided distinct issues for waitlisted patients, transplant recipients, and transplant organizations.

Method

We searched Scopus using the terms “transplant” and “transplantation,” and organ-related phrases like “intestin*,” “liver,” “kidney,” “hepatic,” “renal,” and “pancrea*,” as well as COVID-19 terms such as “COVID-19,” “coronavirus,” and “SARS-CoV-2.” We included articles, reviews, conference papers, letters, notes, editorials, brief surveys, book chapters, and errata and studied nations, institutions, authors, journals, keywords, and articles. VOSviewer 1.6.18 and Excel were used to create tables and figures.

Results

We included 1,251 of 1,256 studies. Among them, 289 (23.1%), 489 (39.1%), and 473 (37.8%) papers were published in 2020, 2021, and 2022, with mean (SD) citations of 30.3 (53.3), 14.3 (26.8), and 4.79 (6.38), respectively. Compared to other abdominal organs, the field of kidney transplants had the highest number of articles describing the impact of COVID-19. The United States contributed the most articles, and the American Journal of Transplantation published the most articles.

Conclusion

To our knowledge, this is the first bibliometric investigation of the impact of COVID-19 on SOT. This report provides an overview of the research conducted on SOT and COVID-19. There is potential for this bibliometric analysis to serve as a beneficial and practical resource for ongoing and future research.

     

Postoperative inverted intercostal hernia incidentally detected by chest computed tomography in a patient with COVID-19

Inverted intercostal hernias are uncommon, and even more so when comprised of soft tissue instead of lung parenchyma in the postoperative context. This report demonstrates a case in with such a hernia was diagnosed through chest multidetector computerized tomography in a 48-year-old woman who presented to the emergency room with respiratory symptoms and tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). She had positive surgical history for left lower lobectomy with bronchoplastic procedure and mediastinal lymphadenectomy, due to an endobronchial typical carcinoid tumor a few years ago. Therefore, it is important for radiologists to be aware of the imaging characteristics of inverted intercostal hernias, to avoid diagnostic errors.