The Predictive Value of Postoperative Clinical Risk Scores for Outcome After Hepatic Resection: A Validation Analysis in 807 Patients

Background

Although early postoperative risk stratification might allow a more precise prediction of outcomes after hepatic resection, evaluation of different postoperative clinical risk indices has been lacking.

Methods

A total of 1,219 patients underwent hepatic resection between January 2002 and 2010, and 807 patients were eligible for final analyses. The model for end stage liver disease (MELD) score, the “50–50 criteria,” and the International Study Group of Liver Surgery (ISGLS) definition of posthepatectomy liver failure (PHLF) were assessed as clinical risk scores on postoperative day 5. Risk factors for morbidity and mortality were analyzed using multivariate logistic regression analyses.

Results

The overall morbidity and mortality rates were 43 and 6%, respectively. Sensitivity of the MELD score, the 50–50 criteria and the PHLF for prediction of morbidity and mortality were 55, 6, 23 and 71, 26, 65%. On multivariate analyses MELD score [odds ratio (OR) 2.06; 95% confidence interval (95% CI) 1.41–3.02] and PHLF (5.61; 2.73–11.55) were associated with morbidity, whereas this association did not reach statistical significance for the 50–50 criteria (3.64; 0.78–17.02). The 50–50 criteria (16.45; 3.50–77.25) and PHLF (13.80; 4.27–44.61) were identified as powerful, independent predictors of mortality. This association was less strong for the MELD score (2.86; 0.98–8.31).

Conclusion

Postoperative clinical risk scores are associated independently with outcome after hepatic resection. Owing to lack of sensitivity only the MELD score can be recommended for early prediction of overall morbidity, whereas the MELD score and the PHLF enabled adequate risk stratification regarding perioperative mortality.     

COVID‐19–infected woman along with tuberculosis and psychogenic non‐epileptic seizures: A case report

During the COVID‐19 pandemic, we should not forget about chronic, underlying and important diseases, especially diseases that cause immune system deficiency, of which TB is one and may be missed. Also, we should pay attention to the past medical history of the patients and their drug‐drug interactions during the treatment period of COVID‐19. Our main clinical message is that diseases such as TB, which weaken the immune system, may predispose a person to COVID‐19 infection and COVID‐19 may exacerbate TB and it’s mortality. On the other hand, diseases that target the lung tissue such as TB and COVID‐19, may have synergistic effects and increase mortality (for a patient whose lung capacity is reduced due to TB, superimposed COVID‐19 can worsen the situation). In addition, it may be necessary to take more serious considerations for COVID‐19 in low socio‐economy countries, such as Afghanistan, where TB is more prevalent     

In vitro release of silver ions and expression of osteogenic genes by MC3T3-E1 cell line cultured on nano-hydroxyapatite and silver/strontium-coated titanium plates

Odontology - Attempts are ongoing to improve the surface properties of dental implants by application of different coatings, aiming to enhance osseointegration, and decrease the adverse effects of...     

Multimodality imaging in the diagnostic approach to a patient with carcinoid heart disease involving four heart valves

Carcinoid heart disease is a rare condition that occurs in less than half of patients with carcinoid syndrome. The disease mainly affects right‐sided heart valves; however, in 5%–10%, it can also involve left‐sided valves. This case illustrates the most complicated form of the disease involving four heart valves.     

Early initiation of B-vitamin supplementation may reduce symptoms and explain intrafamilial variability: Insights from two sibling pairs from the TANGO2 natural history study

TANGO2-deficiency disorder (TDD) is an autosomal recessive condition arising from pathogenic biallelic variants in the TANGO2 gene. TDD is characterized by symptoms typically beginning in late infancy including delayed developmental milestones, cognitive impairment, dysarthria, expressive language deficits, and gait abnormalities. There is wide phenotypic variability where some are severely affected while others have mild symptoms. This variability has been documented even among sibling pairs who share the same genotype, but reasons for this variability have not been well understood. Emerging data suggest a potential link between B-complex or multivitamin supplementation and decreased metabolic crises in TDD. In this report, we describe two sibling pairs from unreladiagnosed with TDD with marked differences in symptoms. In both families, the older siblings suffered multiple metabolic crises and are clinically more affected than their younger siblings who have very mild to no symptoms; they are the least impaired among 70 other patients in our ongoing international natural history study. Unlike their older siblings, the two younger siblings started taking B-complex vitamins early between 9 and 16 months. This report delineates the mildest presentation of TDD in two families. These data may support a role for early diagnosis and initiation of vitamin supplementation to not only prevent metabolic crises but also improve neurologic outcomes in this life-threatening disorder.