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Nilanchali Singh, Reva Tripathi, Ym Mala, Shakun Tyagi
Published: 19 November 2021
Surgical Case Reports, Volume 2021, pp 1-2; https://doi.org/10.31487/j.scr.2021.11.05

Abstract:
Introduction: Herlyn-Werner-Wunderlich Syndrome is a rare anomaly and exact incidence is not known. It is usually diagnosed in young girls who present with cyclical abdominal pain along with cyclical menstruation. Case Report: We present case of two girls who had this syndrome. An ultrasound was performed in both patients. In first patient, it revealed uterus didelphys with hematocolpos on right side. In the second patient, a large hematometra of size 9.8×12.2 cm, along with hematocolpos was present on the left side. Both the patients underwent examination under anaesthesia and excision of septum. They remained asymptomatic during one year follow-up. Conclusion: Treatment of such cases is excision of septum and to maintain the patency of the outflow tract and prevent stricture formation later. A good follow-up in immediate post-operative period is necessary.
Changku Jia, Zhuangming Yu, He Li, Fei Sun, Hongjian Chen, Fengbo Zhang, Linjiang Li, Ping Long, Yunjian Wei, Jun Wang, et al.
Published: 18 November 2021
Journal of Surgical Oncology, Volume 2021, pp 1-8; https://doi.org/10.31487/j.jso.2021.03.01

Abstract:
Background: Venous thromboembolic events (VTE) are common causes of morbidity and mortality in glioblastoma patients. Mutation in the isocitrate dehydrogenase 1 enzyme (IDH1) is frequent in secondary glioblastoma and results in altered metabolomics. Objectives: This study evaluates whether IDH-1 status correlates with incidence of VTE in glioblastoma patients. Methods: Observational study of 398 cases of patients with glioblastoma, who all underwent surgery in a regional Neurosurgical centre between April 2012 and December 2014. IDH -1 status and Tissue factor (F3) protein expression were assessed by immunohistochemistry. Deep venous thrombosis (DVT) and pulmonary embolism (PE) were diagnosed by Doppler ultrasound and pulmonary CT angiogram respectively. Results: 336 cases were wild type (WT) IDH-1 (94.1%) and 21 cases were IDH-1 mutated (R132H) (5.9%). 51 patients had a thromboembolic event (15.3%), with all cases of VTE in WT IDH-1 tumors, a rate of 21.8% within this group. IDH-1 status had a significant correlation with VTE (p=0.033 Fisher exact test). As expected, mutant IDH was associated with prolonged patient survival (p=0.024 Log rank). The mean expression in IDH-1 wild type GBM was 7.14 and in R132h mutant GBM was 4.87 (log2 scale). This was highly statistically significant with a corrected P value of less than 0.0001. Conclusion: A significant association exists between IDH1 status in glioblastoma patients and the risk of VTE. Patients with wild type IDH-1 appear at high risk of VTE and appropriate precautions should be considered.
Giada Garufi, S Cardali, G Ricciardo
Published: 12 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.02

Abstract:
Sclerosing meningioma is a rare histological variant of meningioma, first described in the literature by Davidson and Hope in 1989 as an invasive bulking mass consisted of whorling collagen bundles with a minimum percentage of meningothelial resembling cells [1]. The literature showed very rare cases of the intramedullary location of sclerosing meningiomas: in our opinion, it is mandatory to describe its clinical, surgical, histological and immunohistochemical features in order to reach the best final outcome. Sclerosing meningiomas are often misdiagnosed because of their invasive behaviour: it does require a correct diagnosis in order to prevent unnecessary postoperative treatment. Literature reports only 30 cases of sclerosing meningiomas and only 2 of them are intramedullary. We present the case of a cervical intramedullary sclerosing meningioma presenting with gait disturbances, sensory deficits, four extremities weakness and hypereflexia in a patient with the history of meningiomatosis.
Flor M Fernández-Gordón Sánchez, Elena Gomez Dominguez, Cristina Garfia Castillo, Jorge Arroyo Andres, Luis Robles Diaz, Yolanda Rodriguez Gil
Clinical Oncology and Research, Volume 2021, pp 1-3; https://doi.org/10.31487/j.cor.2021.10.03

Abstract:
Immunotherapy with checkpoint inhibitors is associated with termed inflammatory and immune-related side effects (irAE). Upper gastrointestinal symptoms are infrequent and appear mainly in patients on combination therapy with two checkpoint inhibitor drugs. We present the case of a patient with IIIB stage cutaneous melanoma treated with Nivolumab in monotherapy who developed an immune-mediated gastritis. Histopathologically, due to the paucity of published cases, no specific pattern of Nivolumab-immune-mediated gastritis has been described. We have reviewed the literature and compared the histopathology of the cases available in the literature.
Wedad H. Al Dahhan, Emad Yousif
Journal of Clinical and Medical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.jcmcr.2021.02.01

Abstract:
With the continued outbreak of the coronavirus and the increase in the need for medical oxygen, it became necessary to take all measures for the safe handling of gas. Oxygen is very reactive and behaves differently to air, compressed air, nitrogen and other inert gases. Medical oxygen, at high pressure, from a cylinder, can react violently with hydrocarbons such as oil and grease which may be used mistakenly in cylinder valve or regulator. The oxidation products are a potentially explosive hydroperoxide. Nearly all materials including rubber, textiles, and metals will burn vigorously in the presence of oxygen. Atmospheric air contains nitrogen 78%, oxygen about 21% and with 1% remaining including a variety of other gases like carbon dioxide and argon. Even a small increase in the oxygen level in the air to about 24% can create a dangerous situation. It becomes easier to start a fire, which will then burn hotter and more fiercely than in atmospheric air and may be impossible to put the fire out. Increase the concentration of oxygen due to leaking valve or hose in a poorly ventilated room or in confined space can quickly create a dangerous level.
Xin Zheng, Yang Su, Haitao Yang
Published: 11 November 2021
Surgical Case Reports, Volume 2021, pp 1-3; https://doi.org/10.31487/j.scr.2021.10.04

Abstract:
Objective: To retrospectively analyse the lung ultrasound images of 60 patients undergoing thoracoscopic partial pneumonectomy and compare the difference of bilateral lung ultrasound images. Results: B3 lines were predominant in ventilating side lung, B7 lines and atelectasis were predominant in operative side lung. Conclusion: Short-term lung injury after one-lung ventilation is mainly on the ventilation side, and the main manifestation is pulmonary edema.
Adriaan Louw, Ellen Wendling, Dustin Hawk, Nicole Sturdevant, Hailey Louw, Kevin Farrell
Psychological Disorders and Research, Volume 2021, pp 1-7; https://doi.org/10.31487/j.pdr.2021.02.01

Abstract:
Objective: To determine if a brief, one-on-one pain neuroscience education (PNE) session delivered by a physical therapist (PT) can influence depression. Methods: A convenience sample of patients with persistent low back pain (LBP) (n = 23) attending PT with moderate to severe depression (Patient Health Questionnaire-9 [PHQ-9]) participated in the study. Patients received a standardized, one-on-one 30-minute PNE session by a PT with pre- and post-intervention measures of low back and leg pain (Numeric Pain Rating Scale [NPRS]), pain catastrophization (Pain Catastrophization Scale [PCS]), pain knowledge (Revised Neurophysiology of Pain Questionnaire [rNPQ] and depression (PHQ-9). Results: Immediately following PNE, all measures improved, with low back and leg pain not being significant (pback = 0.345 and pleg = 0.633), while pain catastrophization (p = 0.047), pain knowledge (p = 0.001) and depression (p = 0.004) reaching significant improvements. The PNE session shifted various patients to lower levels of depression, with 21.8% of the patients’ improvement in depression meeting or exceeding the minimal clinical important difference. Conclusion: PNE may be a safe, clinically effective way to help a subgroup of patients attending PT with depression. More studies are needed to further explore the results from this pilot study.
Yihong Huang, Wenlu Dai, Chunyu Li, Depeng Li, Zhenyu Li, Qunxian Lu, Haiying Sun, Baolin Li, Kailin Xu
Clinical Oncology and Cancer Biology, Volume 2021, pp 1-6; https://doi.org/10.31487/j.cocb.2021.02.01

Abstract:
We investigated the efficiency of mitoxantrone (MIT) and high-dose cytarabine (Ara-C) chemotherapy followed by G-CSF and G-CSF/GM-CSF treatments for the mobilization of peripheral blood stem cells (PBSCs) in patients with leukemia and lymphoma. MIT was intravenously injected at 10 mg/(m2·d) for 2 to 3 days, followed by Ara-C injected intravenously at 2 g/m2 every 12 hours for 1 to 2 days. When white blood cell count recovered from the lowest value, 5 to 7.5 μg/ (kg·d) G-CSF was administered in 23 patients for 5 to 7 successive days. Another 27 patients received 3-5 μg/ (kg·d) G-CSF and 3-5μg/ (kg·d) GM-CSF. Autologous peripheral blood mononuclear cells were collected. Levels of CFU-GM and CD34+ cells were determined after unfreezing. The CD34+ cells and CFU-GM yields of 27 patients in G-CSF plus GM-CSF combination group [(8.79±3.11)×106/kg, (3.52±1.34)×105/kg, respectively] were significantly higher than those of patients receiving G-CSF alone (n=23) [(6.14±2.06)×106/kg, (2.03±1.06)×105/kg, respectively (P < 0.05)]. No obvious changes of T lymphocyte subsets in patients were observed when using G-CSF/GM-CSF, but levels of CD34+ cells increased gradually (P>0.05). The end-point separation blood volume was all above trebling TBV. No severe complications were observed during the mobilization and collection. Autologous PBSCT obtained quick hematopoietic reconstitution. In conclusion, MA chemotherapy combined with G-CSF alone and G-CSF/GM-CSF can safely and effectively mobilize autologous PBSCs, while G-CSF plus GM-CSF is superior to G-CSF alone. Large volume leukapheresis is an important method to enhance the production rate of stem cells and decrease harvesting time.
Mohamed A. Elkoushy, Sameer A Munshi, Mohnna S Subahi, Shafaq Mujtaba
Published: 8 November 2021
Surgical Case Reports, Volume 2021, pp 1-3; https://doi.org/10.31487/j.scr.2021.10.06

Abstract:
Metanephric adenoma (MA) of the kidney is a rare benign neoplasm, which is mostly incidental-discovered during imaging studies for other clinical problems. However, this tumor may overlap in morphology with the papillary renal cell carcinoma and there are descriptions of metastatic disease. To date, fewer than 200 cases of MA have been reported worldwide and usually have a good prognosis. In the current report, a case of MA in a middle-aged lady is presented, which developed postoperative morbidity resulting from prolonged perinephric leakage secondary to urinary and perinephric fungus infection as a part of systemic candidiasis. The clinical, morphological and immunohistochemical features are presented together with a review of the current literature.
Litty Joseph, Lakshmi Ps
International Journal of Cancer Science and Therapy, Volume 2021, pp 1-8; https://doi.org/10.31487/j.ijcst.2021.02.04

Abstract:
Background and Aim: Cancer is a disease of complex aetiology and is characterised by uncontrolled growth of abnormal cells. It is a major worldwide health problem. Many natural and synthetic chalcone or their derivatives showed anticancer activities. The aim of the present study is to evaluate the anticancer activity of novel chalcone derivatives and also to establish possible mechanism of action. Materials and Methods: A series of chalcones 3-(3-phenoxyphenyl)-1-phenylprop-2-en-1-one (2a); 1-(4-chlorophenyl)-3-(3-phenoxyphenyl) prop-2-en-1-one (2b); 1-(4-fluorophenyl)-3-(3-phenoxyphenyl) prop-2-en-1-one (2c); 1-(4-Nitro-phenyl)-3-(3-phenoxy-phenyl)prop-2-en-1-one (2d); 1-(4-methoxyphenyl)-3-(3-phenoxyphenyl) prop-2-en-1-one(2e) were evaluated for the cytotoxic activity both in vitro and in vivo. The in vivo antitumor activity of these compounds was estimated on Daltons Ascites Lymphoma induced solid tumor model. The effect of promising compound was further analysed by flow cytometer and RT- PCR analysis. Results and Conclusion: 1-(4-methoxyphenyl)-3-(3-phenoxyphenyl) prop-2-en-1-one and 1-(4- chlorophenyl)-3-(3-phenoxyphenyl) prop-2-en-1-one was showed in vitro cytotoxic activity, DNA damage and antiproliferative activity. DLA induced solid tumor model suggested that 1-(4-methoxyphenyl)-3-(3- phenoxy phenyl) prop-2-en-1-one significantly reduced the tumor volume, increase the percentage tumor inhibition and reverse the haematological parameters. Flow cytometry analysis concluded that the compound induces cell cycle arrest at G0/G1 phase due to the over expression of p21. 1-(4-methoxyphenyl)-3-(3- phenoxy phenyl) prop-2-en-1-one may be a potential agent for cancer treatment.
Silvia Busquets, Marta Castillejo, Queralt Jove, Alina Noguera, Francisco J. López-Soriano, Josep M. Argilés
International Journal of Cancer Science and Therapy, Volume 2021, pp 1-6; https://doi.org/10.31487/j.ijcst.2021.02.02

Abstract:
Background: Accelerated muscle and adipose tissue loss are two of the main aspects of cancer cachexia. β2-agonists seem to be successful in the treatment of cachexia in experimental animals. The aim if the present investigation was to study the effects on body weight loss in tumor-bearing animals of a combination of formoterol and AR-42, an inhibitor of histone deacetylase (HDAC). Methods: Rats were divided into two groups, namely controls (C) and tumor-bearing (T). TB group was further divided into four subgroups: untreated (saline as a vehicle), treated with Formoterol (F) (0,3 mg/kg body weight in saline, subcutaneous (s.c.), daily), treated with AR-42 (A) (20 mg/kg body weight in olive oil, intragastric (i.g.), only the last 4 days). and double-treated treated (TFA) with Formoterol (0,3 mg/kg body weight, subcutaneous (s.c.), daily) and AR-42 (20 mg/kg body weight in olive oil, intragastric (i.g.), only the last 4 days). 7 days after tumor transplantation, muscle weights, grip force and total physical activity were determined in all experimental groups. Results: The presence of the Yoshida AH-130 ascites hepatoma induced severe muscle wasting in rats. Treatment of the tumor-bearing animals with the beta2-agonist formoterol (0,3 mg/kg), resulted in a significant improvement in the cachectic state of the animals. Treatment of the tumor-bearing animals with AR42 did not result in any effects on muscle wasting in the cachectic rats. Furthermore, the combination of formoterol and AR42 showed no additional effects to those observed with just formoterol. Conclusion: The results presented question the previously described effects of AR42 on cancer cachexia, probably due to its effect on tumor growth.
Lili Liu, Xiuming Zhu, Hongming Pan
Published: 5 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.07

Abstract:
SMARCA4 mutant non-small cell lung cancer (SMARCA4m-NSCLC) has a poor prognosis owing to rapid growth. Effective treatments for SMARCA4m-NSCLC have not yet been established. Recently, many preclinical studies support the hypothesis that SMARCA4m-NSCLC may be vulnerable to immune checkpoint inhibitors. Here, we report a patient with programmed death-ligand1 (PD-L1) highly expressive SMARCA4m-NSCLC who showed an extremely rapid and long-term response to pembrolizumab. He was referred to our hospital for a mass of the right lung. Positron emission tomography-computed tomography showed right lung tumor, hilar, mediastinal and bone metastases. Pathological and immunohistochemical results showed it was a lung adenocarcinoma and revealed the tumor proportion score of PD-L1 was 80%. SMARCA4 and K-RAS genes were co-mutations. BRG1 protein expression was negative. Subsequently, pembrolizumab treatment as the first line of therapy was commenced for the patient. With only one dose, pembrolizumab significantly inhibited tumor growth and a partial response was obtained. To date, pembrolizumab treatment has been continued for about 29 months. Severe immune-related adverse events were not observed. Our case showed that an extremely rapid and long-term response can be achieved with pembrolizumab for PD-L1 highly expressive SMARCA4m-NSCLC. Immune checkpoint inhibitors treatment may be a promising strategy for PD-L1 positive SMARCA4m-NSCLC.
Jo-Celine M. Leong, Erin Camille A Caritativo, Ma Socorro C Martinez, Jay B Villavicencio, Manuel M Mariano
Published: 4 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.01

Abstract:
Von Hippel-Lindau syndrome is a rare genetic condition characterized by the development of benign and malignant tumors in various organ systems. We report a case of a 58-year-old Filipino male with unremarkable family history who presented with progressive right homonymous hemianopia. Work up revealed presence of retinal and CNS hemangioblastomas as well as renal cell carcinoma. Confirmatory gene testing is pending but is ultimately not required to make the diagnosis.
Filip W. N. Haenen, T Sloane Guy, Inez Rodrigus
Published: 3 November 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.11.10

Abstract:
Background: Barbed sutures have rarely been used in cardiac surgery. The reason is the absence of safety and feasibility data. This study was set up to assess the safety and efficacy using barbed sutures for right atrium cannulation-site closure both in short and longer-term follow up. Methods: Ten patients undergoing routine CABG through sternotomy with the use of ECC were included after giving written informed consent. After performing CABG, closure of the venous cannulation site at the right atrium is performed, using Stratafix® 2/0 non-resorbable, spiral polypropylene (SXPL1B400), without knotting. Results: No postoperative bleeding complications or revisions for bleeding or tamponade were noted. No complications or major adverse cardio-cerebrovascular incidents were registered during follow-up. The relevance of this lies in the difficulty in tying timely knots, even in experienced hands, during scopic or minimally invasive procedures. Being able to avoid this cumbersome procedure would largely reduce time spent on tying knots (the single most efficient time reducing step in minimally invasive cardiac surgery). Conclusion: Using knotless barbed sutures with an additional self-locking manoeuvre is feasible for the closure of the right atrium cannulation site in cardiac surgery, with no short-term or long-term complications. This opens up possibilities using knotless barbed sutures safer in minimally invasive cardiac surgery. This study confirms barbed knotless sutures perform adequately when closing a low-pressure cardiac structure, and in such, potentially saving time in minimally invasive surgery. Further investigation in closure of other cardiovascular structures is advisable and are planned by the authors.
Augusta Cardoso, Gustavo Coelho, Joana Esteves, Horacio Costa
Published: 29 October 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.10.01

Abstract:
Introduction: Breast conserving surgery plus radiation therapy and mastectomy procedures has equal results in terms of survival. Oncoplastic surgery principles along with breast reduction techniques allow for very good aesthetic results in immediate breast reconstruction with local tissues in several well-defined clinical scenarios. Nevertheless, we still find several limitations to their use regarding the location of the tumor or the need for inconvenient skin resections out of the standard markings of breast reduction. We present a case where traditional breast reduction techniques were inadequate and technical modifications of standard markings and pedicle design were developed to avoid the need to undergo a mastectomy. Methods: We present a patient diagnosed with breast cancer where the clinical characteristics of the tumor (location, skin excision needed) precluded the use of traditional oncoplastic breast reduction techniques. Modifications to the traditional breast reduction techniques were used to cope with the oncological resections needed. Results: A good global symmetry and aesthetic result were achieved. Scar pattern obtained was considered relatively camouflaged and patient satisfaction was high. Conclusion: Breast reduction procedures can be the solution for the treatment of breast cancer. The location of the tumor in the superior quadrants outside standard markings and the need to include skin in the tumor resection can be sidetracked by using enlarged NAC pedicles with modifications to classic skin markings without compromising oncologic safety. The final aesthetic results obtained are considered very good and the patient is very satisfied.
Salvador Macias-Diaz, Ana Lilia Castruita Avila, Joaquin Gabriel Reinoso Toledo, Mario Garcia Carrasco
Clinical Oncology and Research, Volume 2021, pp 1-4; https://doi.org/10.31487/j.cor.2020.10.04

Abstract:
Background: Vitamin D deficiency has been associated with not achieving a complete pathological response in patients with breast cancer after neoadjuvant chemotherapy. The objective of this study was to determine whether vitamin D deficiency is associated with tumor response failure in patients with breast cancer operated and who received neoadjuvant chemotherapy. Materials and Methods: This was a prospective, cross-sectional, analytical and observational study. Vitamin D was measured in patients with breast cancer who had received neoadjuvant chemotherapy and its association with tumor response was determined. For the inferential analysis, the Student’s t-test, chi-square test, and Fisher’s exact test were used. A p value <0.05 was considered statistically significant. Results: Thirty-six patients were included. There was tumor response failure to treatment in 69.3% and vitamin D deficiency occurred in 58.3%. No association was found between vitamin D deficiency and tumor response failure (p = 0.729), histological type (p = 0.691), molecular profile (p = 0.969), clinical stage (p = 0.468) or menopause status (p = 0.701). Conclusion: Vitamin D deficiency is not associated with tumor response failure in breast cancer patients who received neoadjuvant chemotherapy.
Miguel Unda, Ana Loizaga-Iriarte, Sheila Mohamed-El Azzouzi, David Gonzalo-Aparicio, Sofía Rey-Gonzalez, Ana I. Serrano-Gutierrez, Elena Riesco-Paredes, Sandra San Cayetano-Talegon
Clinical Oncology and Research, Volume 2020, pp 1-5; https://doi.org/10.31487/j.cor.2020.10.02

Abstract:
Background: Hypotheses defend BCG being able to have an impact on the course of COVID-19 disease, decreasing the rate of infections and their severity. Objective: To determine if the incidence and severity of COVID-19 are less in patients who receive adjuvant treatment with intravesical BCG for non-muscle invasive bladder cancer and if the number of instillations are influential. Methods: All the participants treated with intravesical BCG between January and June-2020 were analysed, researching if they had been infected, and comparing them with the infection rate in the general reference population of our Hospital. Ethical Aspects: The Healthcare Ethics Committee of the Hospital approved the study and informed consent forms were delivered to patients treated with BCG in order to authorize the use of their data in this study. Statistical Analysis: OpenEpi (Link) statistical analysis was carried out by means of 2×2 tables applying the chi-square statistic and Fisher test for qualitative variables. Results: 117 patients, 23 women (19.7%) and 94 men (80.3%), received treatment with BCG. The mean age was 72.12 years; all ≥50 years. Seven in induction phase, 6 weeks, and 110 in 1-year maintenance, 3 weeks to 3, 6 and 12 months, excluding those that had <4 instillations. Three patients (2.56%) were infected with moderate disease that required admission to the ward. None in the Intensive Care Unit. In the general population, 8558 (5.7 %) were infected. 2015 (1.35%) required admission to the ward and 185 (0.12%) in the Intensive Care Unit. There are no statistically significant differences in the infection rate. Neither was there any in the incidence of moderate or severe disease nor in the incidence of disease between the different phases of the intravesical treatment. Conclusion: We have not been able to demonstrate that intravesical BCG impacts the incidence rate or the severity of COVID-19.
Luisa Aguirre Buexm, Danielli Aparecida de Souza Silva, Bruna Areas Ribeiro, Rayane Figueiredo Silva Moreira Carvalho, Julia Moraes Ferreira, Marina Siqueira Teixeira, Alessandra Oliveira Ferrari Gomes, Frederico Paes Barbosa
International Journal of Cancer Science and Therapy, Volume 2021, pp 1-3; https://doi.org/10.31487/j.ijcst.2021.02.03

Abstract:
Cancer is a major worldwide health problem, being an important cause of morbidity and mortality to population. In global scale, nervous system cancers represent around 1.8% of all malignant tumors in the planet. From 2020 to 2022, it’s estimated around 11.090 new cases of this type of cancer in Brazil. This study aims to raise epidemiological data on central nervous system tumors admitted to the oncology department of a reference hospital in the North Fluminense region in Brazil. Forty-four patients were included in this study, who were predominant males (56.8%), aged between 41 to 60 years old (47.7%), with tumors located primarily in the brain (65.9%) and histopathologically classified as glioblastomas (38.6%). Patients had no family history of cancer (64.3%), were non-smokers (68.2%), non-alcoholics (70%), undergoing primary surgical treatment (34.1%), who did not undergo adjuvant treatment (84.1%) and who died from the disease (66.7%). Glioblastoma was the most incident malignant neoplasm, followed by astrocytoma for both sexes, corroborating with literature data. In summary, this work contributes to a better understanding of these tumors, focusing on their prevention, early diagnosis and treatment.
Alessandro Gennai, Bruno Bovani, Mattia Colli, Fabrizio Melfa, Domenico Piccolo, Rosalba Russo, Matteo Tretti Clementoni, Silvia Zia, Barbara Roda, Andrea Zattoni
International Journal of Regenerative Medicine, Volume 2021, pp 1-10; https://doi.org/10.31487/j.rgm.2021.02.02

Abstract:
Background: Injection of autologous adipose-derived stem cells (ADSCs) and a stromal vascular fraction (VSF) into dermal and subdermal layers promises regenerative advantages by improving skin volume and rejuvenation. Injectable hyaluronic acid (HA) is a temporary dermal filler that, by improving skin hydration, reduces the appearance of fine lines and wrinkles, facial folds and creates structure and volume to the face and lips. This study combined the grafting of micro fragmented fatty tissue with the hyaluronic acid filler procedure, using three different types of HA. Methods: Each sample of micro fragmented adipose tissue harvested using the superficial enhanced fluid fat injection (SEFFI) technique collected from 8 patients were equally divided into two specimens. One of these (EMU specimens) was emulsified by gently applying ten back-and-forth passages from one syringe to another to fluidify the tissue. The other one was not emulsified (Ctrl/NON-EMU specimen). Both EMU and NON-EMU specimens were divided into four aliquots: one served as control, and the others were combined with each of three tested hyaluronic acids. Afterward, we assessed the cellularity of mesenchymal phenotype (defined as the number of adherent cells with mesenchymal phenotype per milliliter of adipose tissue) and the in vitro capacity of differentiation in mesenchymal lineages. Results: Despite low cellularity from emulsified samples combined with HA, isolated cells could grow and expand in culture, thus proving their proliferative ability, showing “good quality” in all conditions (Ctrl/NON-EMU, EMU, and combined with HA). The cells could differentiate towards mesenchymal lineages, express mesenchymal markers by flow cytometry analysis, and maintain their stemness potential. Conclusion: The combination of emulsified harvested tissue with HA products can be exploited to counteract the loss of volume and skin aging of the human face and body. This approach to regenerative aesthetic treatment is a promising treatment for facial antiaging therapy.
Georgios Stefanakis, Vasileia Nyktari, Georgios Papastratigakis, Panagiotis Vardakis, Periklis Vasilos, Emmanouela Koutoulaki
Journal of Surgical Oncology, Volume 2021, pp 1-3; https://doi.org/10.31487/j.jso.2021.02.05

Abstract:
We report a case of pulmonary embolism during resection of a mediastinal mass requiring intraoperative thrombolysis. The diagnosis, although difficult to establish due to simultaneous bleeding and technical difficulties with transthoracic echocardiography, was based on the patient’s history and clinical evidence of low cardiac output and was confirmed by clinical improvement post thrombolysis. When awakened in the intensive care unit, the patient was found to be blind and also required a tracheostomy. We present this case, as it requires complex clinical reasoning throughout different stages of its management and it demonstrates that, when facing an imminent disaster, a risky decision not necessarily conforming to current practice but based on individualisation of treatment can be life-saving.
Rosita Bihariesingh, R Bansie, J Froberg, N Ramdhani, R Mangroo, D Bustamente, E Diaz, I Thakoer, S Vreden, Z Choudhry, et al.
Anesthesia and Clinical Research pp 1-12; https://doi.org/10.31487/j.acr.2021.02.03

Abstract:
Introduction: Although convalescent plasma (CP) treatment is a potential therapeutic option for patients with COVID-19, there is a paucity of data from intensive care unit (ICU) patients with COVID-19 in low-resource settings, such as Suriname. CP was produced by a novel gravity-based filtration method. Methods: In an open-label, multi-center, non-randomized prospective clinical trial, patients with severe or life- threatening COVID-19 symptoms (n=28) with CP treatment were compared with standard treatment alone (n=50). A pre-planned interim analysis is reported. The primary endpoint was a 28-day ICU mortality. Secondary endpoints were changes two days after treatment initiation in pulmonary oxygen exchange capacity (PF ratio) and chest x-ray (CXR) score. Results: Mortality occurred in 18% (CP: 5/28) vs. 36% (Control:18/50). CP treatment of severe COVID-19 resulted in a higher probability of survival, with a hazard ratio (HR) of 0.22 (95% CI, 0.074-0.067), correcting for age, the presence of diabetes and COVID-19 severity. In the severe group, CP resulted in an improved CXR score (P = 0.0013) and increase in PF ratio (P = 0.011) as compared to standard therapy. The gravity-based plasmapheresis method used for CP production was well-tolerated and no adverse events were observed in the donors. Discussion: CP therapy in combination with standard treatment resulted in 78% reduction of 28-day ICU mortality (HR = 0.22) compared to standard treatment alone. Both CXR-score and PF ratio changes represent effective indicators for the treatment effect of CP after two days. The novel CP production method was effective and represents a practical solution for Low- and middle-income countries to produce CP.
Long Jiahuan Xanicia, Ng Kok Kit
Published: 15 October 2021
Surgery Case Reports pp 1-6; https://doi.org/10.31487/j.jscr.2021.02.03

Abstract:
Renal lymphangiectasia (RLM) is a rare condition characterized by dilatation of perirenal, parapelvic or intrarenal lymphatics. We report an unusual case of bilateral RLM in a 20-year-old Malay male who presented with 1 month duration of bilateral flank pain. Bedside ultrasound showed bilateral perinephric collections, which were further confirmed on computer tomography intravenous pyelogram (CT IVP). Other causes of perinephric collections were ruled out based on laboratory and radiological findings, and he was managed conservatively as for RLM with surveillance ultrasound kidneys at 3 to 6 monthly intervals.
N. Baskaran, S Vignesh, V Chandrasekar
Clinical Oncology and Research, Volume 2021, pp 1-9; https://doi.org/10.31487/j.cor.2021.08.11

Abstract:
Biomarkers are substances that are either secreted by the tumor or produced by the body in response to the presence of cancer. Biomarkers serve as an objective measure for evaluation of normal and pathological processes as well as pharmacological responses to a therapeutic intervention. Cancer studies are usually difficult to interpret, especially based on the contemporary medical diagnosis. In this circumstance, biomarkers are developing as reliable diagnostic metabolites, which have many promising applications in oncological screening, differential diagnosis, risk assessment, response to treatment, and examining the progression of disease. Genome or protein based prognostic biomarkers are available, for numerous cancer types, for potential inclusion into clinical prognostic staging methods. However, there lies difficulty in translating these biomarkers into clinical outcomes. This review concerns important biomarkers related to wide varieties of cancer and also elucidates mode of action of few major biomarkers.
Dimitra Charatsi, Polyxeni Vanakara, Michail Nikolaou, Aikaterini Evaggelopoulou, Dimitrios Korfias, Foteini Simopoulou, Nikolaos Charalampakis, Dimitrios Schizas, Alexandros Daponte, George Kyrgias, et al.
Vaginal Dilator Use to Promote Sexual Wellbeing After Radiotherapy in Gynaecological Cancer Survivors: A Prospective Observational Study; https://doi.org/10.31487/j.ijcst.2021.03.01.sup

Abstract:
Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.
Dimitra Charatsi, Polyxeni Vanakara, Michail Nikolaou, Aikaterini Evaggelopoulou, Dimitrios Korfias, Foteini Simopoulou, Nikolaos Charalampakis, Dimitrios Schizas, Alexandros Daponte, George Kyrgias, et al.
International Journal of Cancer Science and Therapy pp 1-13; https://doi.org/10.31487/j.ijcst.2021.03.01

Abstract:
Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.
Khalid Iqbal, Noreen Amjad, Sumera Butt, Fajar Rafi Ranjha, Sajid Anees Minhas, Qurat Ul Ain Shamsi
Clinical Oncology and Research, Volume 2021, pp 1-7; https://doi.org/10.31487/j.cor.2021.09.06

Abstract:
Purpose: The study of clinical effectiveness of deep-inspirational breath-hold (DIBH) in left breast cancer radiotherapy (RT) was aimed at focusing on dosimetry and organs at risk (OARs) evaluation. A retrospective study was conducted to assess the heart and ipsilateral lung V30 for DIBH technique and to compare with free breathing (FB) technique. Clinical data shows that by increasing the inhalation amplitude value (cm), the maximum heart distance decreases in the treatment field. Materials and Methods: Thirty left-sided breast and chest wall patients were CT scanned on 4DCT with DIBH. These patients were chosen for the DIBH technique with the ability to hold their breath for more than 20 seconds. Radiotherapy of these patients was planned using field-in-field planning technique, and OAR doses were observed using the institutionally specified DIBH protocol. Results: The mean heart dose was less than 3Gy. Whereas V2Gy and V10Gy were less than 30% and 5%. The mean ipsilateral lung dose was 7.59 Gy. Ipsilateral lung V30 was less than 25% with ±10% margins. It is found that by increasing the inhaling amplitude (cm) heart involvement in the tangential treatment field decreases. Conclusion: DIBH is an easy and highly efficient treatment technique for reducing the mean dose of the heart and V30 of ipsilateral lung. The maximum heart distance decreases as the baseline of inhalation increases due to heart doses.
Sanjula Virmani, Vishnu Datt, C S Joshi, Harpreet Singh Minhas, Subodh Satyarthi, Indira Mallik
Anesthesia and Clinical Research pp 1-7; https://doi.org/10.31487/j.acr.2021.02.02

Abstract:
Background: The aim of the present study was to study the hemodynamic profile of dexmedetomidine during induction and distal anastomosis of coronary arteries in patients undergoing OPCAB in comparison to the institutional practice of using midazolam. Methods: In Group I, (n=25) patients were anaesthetised using fentanyl, pancuronium bromide, Isoflurane and midazolam. Group II (n=25) patients received a loading dose of dexmedetomidine infusion (1µg/Kg) over 10 minutes followed by an infusion of dexmedetomidine at the rate of 0.6 µg/Kg/hour, along with fentanyl, Pancuronium bromide and isoflurane. Heart rate (HR) mean arterial pressure (MAP), pulmonary artery (PA) catheter derived data and BIS were recorded at baseline, at 1 and 3 minutes after induction, at 1, 3 and 5 minutes after intubation, and at 5 and 30 minutes after protamine administration. MAP and HR were recorded every 10 min during the operation, except during distal anastomosis of the coronary arteries when it was recorded every 5 minutes after application of the Octopus tissue stabilising system. Results: The intubation response by way of increase in HR was much less in group II and stabilized by 5 min after intubation. The accompanying hypotension at 1 minute after induction was more in group II, but it was clinically acceptable (81.68±21.74 mm Hg). During distal graft anastomoses HR was in the range of 68 beats/min to 85 beats/min in group II vs. 85 beats/min to 100 beats/min in Group I. The MAP was lower in this group during the distal anastomosis, but it was within clinically acceptable range (> 65 mm Hg). Conclusion: Dexmedetomidine is a viable option as an anaesthetic adjunct in a loading dose of 1µg/Kg followed by an infusion of 0.6 µg/Kg. Future studies will be necessary to show if this provides any outcome benefits.
Michael Herzog, Andreas Velten, Benjamin Velten, Vasyl Bogdanov, Daniel Grafmans
Case Reports and Series in Surgery, Volume 2021, pp 1-3; https://doi.org/10.31487/j.crss.2021.02.04

Abstract:
Background: Radiation-related hypopharyngeal stenoses are considered as complications after larynx sparing therapy of hypopharyngeal or laryngeal tumors. Methods: The reported patient suffered from chondronecrosis of the cricoid after radiation of a larynx carcinoma and was treated by removing the necrotic cartilage. To prevent emerging stenosis of the hypopharynx, a customized hypopharyngeal stent was constructed on the basis of CT scan data. The Y-shaped stent was placed dorsal to the larynx, caudal to the arytenoid cartilages and remained in place without dislocation or irritation of the larynx for 8 weeks. During that time, the hypopharynx was stented, and the mucosa grew around the stent covering the complete circumference of the hypopharynx again. 18 weeks after removal of the stent, the hypopharynx did not reveal any re-stenosis. Conclusion: This customized hypopharyngeal stent is the first reported approach applied with spared larynx, which has been tolerated for a long period of time.
Zhicai Zhang, Quanshan Sun, Ling Xu, Wenjing Shi, Xiaocui Liu, Chongyang Ding, Huihua Zheng, Feng Wang
Journal of Food Nutrition and Metabolism, Volume 2021, pp 1-10; https://doi.org/10.31487/j.jfnm.2021.02.03

Abstract:
In the present study, we evaluated the hypoglycemic, hypolipidemic and anti-peroxidative effects of yam rice powder (YRP) derived from Tremella aurantialba on streptozotocin (STZ)-induced diabetic mice and diabetic patients. Diabetic mice were treated with ethanol extract of YRP (EEYR) at three doses or YRP for 30 days. Diabetic patients were treated with ethanol extract solution of YRP (ESYR) for 4.5 months. Results indicated that EEYR administration significantly reduced levels of fasting blood glucose (FBG), serum fructosamine, total cholesterol, total triglyceride and malondialdehyde, and increased glucose metabolism velocities and superoxide dismutase level in the serum compared with diabetic controls (p<0.01). Moreover, ESYR could replace chemical drugs to control the FBG and postprandial blood glucose levels of diabetic patients. Our results suggested that YRP could enhance hypoglycemic, hypolipidemic and antioxidant properties in STZ-induced diabetic mice and diabetic patients. Collectively, YRP might be used as food to prevent or manage diabetes.
Roberto Valente, Alfredo Torretta, Dimana Kaludova, Mayank Roy, Satya Bhattacharya
Published: 5 October 2021
Surgical Case Reports pp 1-6; https://doi.org/10.31487/j.scr.2021.10.03

Abstract:
Background: Major bile duct injuries (BDIs) are hazardous complications after laparoscopic cholecystectomy (0.4%-0.6% of all laparoscopic cholecystectomies) [1, 2-4]. Major BDIs usually require surgery, ideally either within one week or after 3 three months after index surgery [1]. We describe the case of iatrogenic transection of the common bile duct (CBD) complicated by a complex full midline abdominal evisceration presented on day 12 after emergency laparotomy for biliary peritonitis. Case Presentation: A 65-year-old male underwent laparoscopic cholecystectomy in a district general hospital and was discharged on the same day, following apparently uneventful surgery. He, however, re-presented two days later with biliary peritonitis when emergency ERCP showed full CBD transection. The local surgical team performed midline exploratory laparotomy, washout, and external drainage aside the leaking CBD and referred the case to our tertiary HPB service. While awaiting transfer (due to bed shortage), full wound dehiscence occurred. On transfer arrival at our HPB service on postoperative day 11, the patient presented extensive evisceration with loss of domain and persisting high-volume biliary spillage aside bowels. Following assessment and fast literature review, we considered operation undeferrable and planned multi-stage surgeries, including primary Roux-en-Y hepaticojejunostomy (HJ) and progressive abdominal wall closure in multiple sessions under general anaesthesia, aided by vacuum-assisted wound closure and intraperitoneally mesh-mediated fascial traction-approximation (VAWCM) with permeable mesh. An expected late incisional hernia was eventually repaired through component separation and biological mesh. Discussion and Conclusion: The complexity of our case lies in the coexistence of 2-weeks biliary peritonitis following early BDI with massive midline evisceration, in combination, both representing over 40% mortality risk, requiring immediate, simultaneous repair. Roux-en-Y HJ and VAWCM have proven safe and effective.
David O. Carpenter, N Hori, Y Tan, Z Xu, N Akaike
Journal of Brain and Nerves, Volume 2021, pp 1-5; https://doi.org/10.31487/j.jbn.2021.01.03

Abstract:
Amyotrophic lateral sclerosis (ALS) is a disease where upper and lower motor neurons die, and it is often associated with mutations of superoxide dismutase 1 (SOD1). We have used mouse models to compare physiologic and morphologic characteristics of cervical motor neurons in wild-type and mutant animals. Slices of the cervical spinal cord were prepared from old wild-type and mutant G93A and G85R mice, and intracellular recordings of membrane potential, resistance and responses to application of excitatory neurotransmitters were studied. Some motor neurons were injected with Lucifer Yellow for morphological analysis. There were no significant differences between membrane potential in the SOD1 mutants and aged wild-type mice, but membrane resistance was somewhat higher in the mutant motor neurons. Dendrites of the mutant motor neurons were not responsive to ionophoretic application of excitatory amino acids, although the cell body responded strongly. In Lucifer-filled cells, the dendrites were found to disappear. Mutant motor neurons were sometimes spontaneously active. Responses of mutant motor neurons to perfused glutamate with varying calcium concentrations in the Ringer’s solution were different from those of the wild-type cells.
, Sanne Pagh Moller, Lau Caspar Thygesen, Henrik Sillesen, Dorthe Overgaard
Improving Rehabilitation for Patients with Intermittent Claudication: A Randomized Controlled Trial with a Mixed-Methods Evaluation (The CIPIC Rehab Study); https://doi.org/10.31487/j.jicoa.2021.04.01.sup

Abstract:
Aim: This study aimed to explore how qualitative data about rehabilitation for patients with intermittent claudication do provide an enhanced understanding of the quantitative experimental results. Background: The study was a randomized clinical trial comparing a rehabilitation intervention with usual care. A statistically significant difference between rehabilitation and usual care was found in walking distance, physical activity, quality of life and diet. The findings from the quantitative and qualitative analyses were analysed separately on their own tradition. In this study, mixed methods address whether the qualitative results could help explain the quantitative results and bring forward additional information. Design: Complex mixed-method intervention design with a convergent questionnaire variant. Methods: From April 2017- May 2019, patients diagnosed with intermittent claudication were included in a randomized clinical trial (N=118). In addition, qualitative interview informants from the intervention group were sampled from the quantitative study population for a survey (N=43) and focus group interviews (N=10). Interviews were conducted from April 2018-August 2019. Results: Integrated analyses identified how improvement in walking distance, physical activity, diet and quality of life was affected by team spirit, pedometer, education and fun exercise in a local setting. Quantitative and qualitative findings primarily confirmed and expanded each other; however, two discordant results were also evident. Conclusion: Our study adds empirical evidence regarding how a mixed-methods study can be used to obtain a more nuanced understanding of complex healthcare problems. The study provides new knowledge concerning how to set up a rehabilitation programme for patients with intermittent claudication.
Maj Siercke, Sanne Pagh Moller, Lau Caspar Thygesen, Henrik Sillesen, Dorthe Overgaard
Journal of Integrative Cardiology Open Access, Volume 2021, pp 1-13; https://doi.org/10.31487/j.jicoa.2021.04.01

Abstract:
Aim: This study aimed to explore how qualitative data about rehabilitation for patients with intermittent claudication do provide an enhanced understanding of the quantitative experimental results. Background: The study was a randomized clinical trial comparing a rehabilitation intervention with usual care. A statistically significant difference between rehabilitation and usual care was found in walking distance, physical activity, quality of life and diet. The findings from the quantitative and qualitative analyses were analysed separately on their own tradition. In this study, mixed methods address whether the qualitative results could help explain the quantitative results and bring forward additional information. Design: Complex mixed-method intervention design with a convergent questionnaire variant. Methods: From April 2017- May 2019, patients diagnosed with intermittent claudication were included in a randomized clinical trial (N=118). In addition, qualitative interview informants from the intervention group were sampled from the quantitative study population for a survey (N=43) and focus group interviews (N=10). Interviews were conducted from April 2018-August 2019. Results: Integrated analyses identified how improvement in walking distance, physical activity, diet and quality of life was affected by team spirit, pedometer, education and fun exercise in a local setting. Quantitative and qualitative findings primarily confirmed and expanded each other; however, two discordant results were also evident. Conclusion: Our study adds empirical evidence regarding how a mixed-methods study can be used to obtain a more nuanced understanding of complex healthcare problems. The study provides new knowledge concerning how to set up a rehabilitation programme for patients with intermittent claudication.
Gobi Hariyanayagam Gunasekaran, Wan Mohd Akmal Bin Wan Sabri, Mohd Ezrul Helmi Bin Jamaluddin
Case Reports and Series in Surgery, Volume 2021, pp 1-4; https://doi.org/10.31487/j.crss.2021.02.01

Abstract:
Deep Vein Thrombosis (DVT) is a common treatment-related complication following surgery and chemotherapy. We are reporting a case of colorectal cancer-associated thrombosis during platinum-based chemotherapy. The patient was treated with Rivaroxaban (Xarelto), a highly selective direct Factor Xa inhibitor. This case report highlights the concurrent use of novel oral anticoagulants, which does not interrupt the chemotherapy schedule among patients receiving cytotoxic agents.
Olivier Choussy, Nicolas Viault, Wahib Ghanem, Antoine Dubray Vautrin, Christian Lamer
Published: 30 September 2021
Surgical Case Reports, Volume 2021, pp 1-2; https://doi.org/10.31487/j.scr.2021.09.13

Abstract:
Epistaxis is a common and a well-known symptom. Nasal packing is an effective treatment in most cases [1]. The COVID-19 disease treatment includes conventional or high flow nasal oxygen therapy and systemic anticoagulation [2]. Patients in intensive care unit may require therapeutic anticoagulation for venous thromboembolism, hyperinflammatory status, extracorporeal membrane oxygenation (ECMO) and multiple other pathologies. The use of therapeutic anticoagulation increases risk of nose bleeding, and its management may be challenging. CAVI-T (Figures 1 & 2) is a new asymmetrical low-pressure balloon that have shown promising results to control epistaxis in emergency. We report herein the management of severe epistaxis in two COVID-19 patients admitted to ICU for severe respiratory failure.
Nell Maloney Patel, Michael Thomas Scott, Shahyan Ur Rehman, June Hsu
Published: 30 September 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.09.12

Abstract:
Anastomotic leak after colorectal surgery can result in serious morbidity for certain patients. The rate of clinically significant anastomotic leak after colon resection ranges from 1.8% to 11.9%. Risk factors include male sex, steroids, smoking, perioperative blood transfusion, malnutrition, and a low anastomosis. However, the effect of pre-operative chemoradiation therapy (CRT) on rates of anastomotic leak is controversial. Specifically, late leaks, which are defined as those that occur greater than 30 days after surgery, are sparsely described in current literature. Recent evidence suggests that CRT may contribute to the presentation of late anastomotic leaks. In this case series, we report our experience with three patients who received CRT and developed varying presentations of a late anastomotic leak. Therefore, our experience supports the consideration of late anastomotic leaks as a separate entity in colorectal surgery. While pre-operative CRT may increase risk for postoperative anastomotic leak overall, further exploration into the relationship between preoperative CRT and late anastomotic leaks is warranted.
John Petrie Iv, Arvind Manisundaram, Irene Yu, Steven Schwaitzberg
Published: 30 September 2021
Surgery Case Reports, Volume 2021, pp 1-3; https://doi.org/10.31487/j.jscr.2021.02.02

Abstract:
Introduction: A 46-year-old female with a past medical history of Graves’ disease refractory to medical management, thus requiring total thyroidectomy presented to clinic for recurrence of her hyperthyroidism and an increasing midline neck mass two years after her index operation. Case Description: CT imaging of the neck mass revealed a locally extensive enhancing abnormality immediately anterior to the hyoid bone within the infrahyoid muscles measuring 1.4x.1.9x4.0 cm. This was consistent with an exceedingly rare proliferation of a thyroglossal duct remnant secondary to recurrence of the patient’s Graves’ disease. The patient was treated with surgical resection of the neck mass shown to be ectopic Graves’ activated thyroid tissue by pathology. The patient was restarted on thyroid hormone replacement therapy and has remained euthyroid to date following surgical resection. Conclusion: The incidence of this event is estimated to be approximately one per a million persons and thus is a rare occurrence in endocrinology. This case highlights the potential shortcomings of surgical management of Graves’ disease. Following surgical resection, the autoimmune status of the patient remains unchanged. Ectopic thyroid tissue can be found anywhere along the embryologic descent of the thyroid gland and as low as the mediastinum. Thus, patients treated with total thyroidectomy should still be monitored regularly for recurrence of Graves’ disease secondary to ectopic thyroid tissue.
David O. Carpenter, N Hori, Z Xu, N Akaike, Y Tan
Published: 30 September 2021
Journal of Brain and Nerves, Volume 2021, pp 1-5; https://doi.org/10.31487/j.jbn.2021.01.02

Abstract:
The effects of age on the physiological properties of cervical motor neurons were examined in slices made from an excised spinal cord graft of ICR mice from the second day after birth to age 350 days. The membrane potential of post-natal day 2 (PD2) to PD350 was about -65 mV and did not change greatly with age, although it was slightly higher at PD2. However, there were significant changes in membrane resistance, which increased with age from about 15 to 30 MΩ. The depolarization induced by the excitatory amino acid agonists, kainic acid, NMDA and AMPA, decreased with aging in spite of the increase in membrane resistance. The motor neurons of the aged mice showed delayed recovery from excitation caused by excitatory amino acid agonists. By injecting Lucifer yellow CH into motor neurons, it was observed that the dendrite trees become thin, and some of the dendrite branches were missing in older animals.
Zhao Linyan, Xin Zheng, Su Yang, Xiong Ying
Published: 30 September 2021
Surgical Case Reports, Volume 2021, pp 1-2; https://doi.org/10.31487/j.scr.2021.10.05

Abstract:
The conditions of emergency patients are complex and variable, and difficult to move, so quick diagnosis and treatment in time is needed. Point of care ultrasound is an efficient tool in critical care. The author conducted preoperative evaluation for perioperative patients and rapid diagnosis for life-threatening factors so as to improve the accuracy and comprehensive preoperative evaluation.
Kianoush Saberi, Alireza Bakhshandeh, Shahnaz Sharifi, Mehrdad Salehi
Published: 30 September 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.09.15

Abstract:
A 16-year-old hemophilia-A patient presented with symptomatic atrial septal defect (ASD). Managing bleeding during cardiovascular surgeries is a significant challenge, even for none-hemophilic patients, due to heparin administration, cardiopulmonary bypass (CPB) coagulopathy and surgical complications. This essay is an effort to discuss ASD, CPB effects on the coagulation system, and highlight some approaches to lower bleeding in hemophilic patients with congenital heart disease.
Sacheen Kumar, R Goburdhun, M Likos Corbett, P H Patel, C Groves, J Chow, A M Young, S Uren, Ma Chaudry
Published: 30 September 2021
Surgical Case Reports, Volume 2021, pp 1-4; https://doi.org/10.31487/j.scr.2021.09.11

Abstract:
Background: Historically, the management for recurrent or persistent Gastro-esophageal reflux disease included selective vagotomy and fundoplication. Despite these surgical interventions, the risk of Barrett’s esophagus (BE) and subsequent malignant transformation remains, requiring cancer resection surgery. We present a case of a patient with a gastro-esophageal junction (GEJ) adenocarcinoma, who underwent a pediatric thoracotomy and Belsey Mark IV fundoplication, and was successfully treated by Laparoscopic Ivor-Lewis Esophagectomy (LILE). Case Presentation: This 64-year-old gentleman with BE and GEJ adenocarcinoma was previously deemed unsuitable for curative surgery due to clinical staging indicating a tumor length of 10cm and suspected invasion of the left pleura. Further staging by Endoscopic ultrasound indicated no evidence of pleural invasion with the distal esophageal thickening in keeping with his previous Belsey Mark IV fundoplication. He underwent neo-adjuvant chemotherapy and a subsequent LILE with complete laparoscopic reversion of the gastric fundoplication without injury to the gastroepiploic artery or fundus. There was sufficient preservation of conduit length to enable a tension free hand-sewn anastomosis with an uneventful post-operative recovery. Final histopathology confirmed ypT1 ypN0 moderately differentiated adenocarcinoma with R0 resection margins. The patient has completed 24 months of cancer recurrence free surveillance. Conclusion: We describe the successful management of a patient by LILE on a background of previous hiatal fundoplication surgery, previously refused curative surgery. We highlight the importance of EUS as a staging modality for such cases showing invasive disease to increase the final clinical staging accuracy. We suggest a minimally invasive approach may be utilized for successful re-do hiatal dissection as an alternative to a conventional open surgery.
Lama Charafeddine, Mariam Anka, Therese Saad, Christelle Tayeh
Journal of Clinical and Medical Case Reports, Volume 2021, pp 1-3; https://doi.org/10.31487/j.jcmcr.2021.02.02

Abstract:
Neonatal thrombosis is a well-described morbidity occurring in the neonatal intensive care unit. Critically ill neonates are most vulnerable to developing thrombosis with serious complications. Fingers and toes ischaemia secondary to vascular occlusion following central lines insertion remains an uncommon occurrence. The therapeutic approach for peripheral tissue injury using local warming, anticoagulants, thrombolytics or topical hyaluronidase showed limited benefits and potential side effects. Here we report an unusual case of finger ischaemia treated successfully using topical nitroglycerine. This complements previous reports confirming the efficacy and safety of this drug and highlighting its potential benefit in neonates.
Parvaneh Shokrani, Maryam Heidari
International Journal of Cancer Science and Therapy, Volume 2021, pp 1-9; https://doi.org/10.31487/j.ijcst.2021.02.05

Abstract:
Gliomas are the most common type of primary central nervous system malignancies with poor prognosis in adults. There are several challenges in developing a treatment protocol for this malignancy including presence of blood-brain barrier that inhibit drug delivery to brain tissue, drug and radiation resistance of tumor cells, and inter and intra-tumor heterogeneity of glioma. In addition, early treatment assessment is difficult for glioma patients because of phenomenon of pseudo-progression. Due to the challenges involved in treatment and monitoring of treatment response for glioma, it is very helpful to identify specific and non-invasive molecular and imaging markers in order to provide useful prognostic information. The aim of this article is to summarize several potential biological and imaging markers regarding malignant glioma. A brief description of the proteins involved in the glioma signaling pathways is provided in order to introduce potential biological markers. Furthermore, the role of imaging techniques in treatment management is discussed. Finally, correlation between tumor characteristics and values of angiogenesis and physiological factors measured in perfusion magnetic resonance imaging techniques as well as metabolites in MRS, and PET tracer’s uptake is investigated.
Markus Pääkkönen
Published: 29 September 2021
Surgical Case Reports, Volume 2021, pp 1-2; https://doi.org/10.31487/j.scr.2021.09.07

Abstract:
Supraclavicular nerves are at risk in operative procedures when surgical incisions are placed over the clavicle. This report describes a 50-year-old man who developed local swelling and redness of the supraclavicular region after undergoing Weaver-Dunn reconstruction of the coracoclavicular ligament. ENMG was consistent with supraclavicular nerve injury. Since the symptoms may mimic infection, the awareness of this complication will aid the clinician to avoid unnecessary use of antimicrobials.
Bruno Soriano Pignataro, Emne Ali Abdallah, Vinicius Fernando Calsavara, Celso Abdon Lopes Mello, Kenji Nishinari, Guilherme Yazbek, Ludmilla Thome Domingos Chinen
Clinical Oncology and Research, Volume 2021, pp 1-8; https://doi.org/10.31487/j.cor.2021.10.01

Abstract:
Background: Cancer-associated thrombosis (CAT) is a major cause of morbidity and mortality in oncology patients. There are no accurate risk assessment tools to predict venous thromboembolism (VTE). Circulating tumor cells (CTCs), circulating tumor microemboli (CTM), and high platelet-lymphocyte ratio (PLR) may predispose to VTE. Objective: To evaluate correlations of CTCs, CTM, and PLR with VTE and progression-free survival (PFS) in gastric cancer patients. Methods: Patients with gastric cancer were recruited (March 2016 to April 2017). CTCs were assayed by ISET at two timepoints: before neoadjuvant treatment (CTC1) and after surgery/before adjuvant therapy (CTC2) for patients with localized disease, and before first-line chemotherapy (CTC1) and after 6 months (CTC2) for patients with metastases. VTE incidence was determined retrospectively. PFS was estimated by Kaplan-Meier analysis. Results: We studied 93 patients. According to Khorana scores, 63 (67.7%) patients were at intermediate and 30 (32.3%) were at high risk for VTE. VTE incidence was 20.4% and CTM were found in 39.8%. VTE developed in 7/37 (18.9%) CTM-positive and in 11/50 (22%) CTM-negative patients (p=0.93). When PLR >288, VTE occurred in 7/14 patients (p=0.005). PLR also associated with poor PFS (p<0.0001). CTC2 was associated with poor PFS (p<0.0001). CTC2, PLR and VTE were independent prognostic factors for PFS (p=0.005, 0.043, and <0.0001 respectively). Conclusion: PLR is a prognostic indicator for PFS and for VTE in gastric cancer. Neither CTC, nor CTM improved risk stratification for VTE in our population.
Ihsan Ceceli, Seyit Mehmet Ceylan
Clinical Oncology and Research, Volume 2021, pp 1-3; https://doi.org/10.31487/j.cor.2021.09.02

Abstract:
Sinonasal undifferentiated carcinoma is a rare malignancy of the head and neck region. Its diagnosis and treatment are difficult due to its rare and aggressive tumor nature and the complex anatomy of its localization. A 70-year-old male who presented with symptoms caused by this rare tumor was reported. The patient presented with pain on the left side of the head and vision loss in the left eye for 1 month, and his endoscopic biopsy was reported as undifferentiated carcinoma. This case report aimed to discuss the diagnosis and treatment of sinonasal undifferentiated carcinoma.
Xu Ma, Yulong Li, Qi Sun, Ting Ding, Li Mu, Hui Yuan
Journal of Integrative Cardiology Open Access, Volume 2021, pp 1-7; https://doi.org/10.31487/j.jicoa.2021.03.04

Abstract:
Background: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a risk predictor for cardiovascular diseases (CVD). Generally, plasma Lp-PLA2 was thought to be secreted by circulatory inflammatory cells. Lp-PLA2 mRNA expression of PBMC may also be a risk predictor. Methods: A total of 104 subjects angiographically verified ACS patients were enrolled, including 73 unstable angina pectoris (UAP) patients and 31 acute myocardial infarction (AMI) patients. Plasma lipids, Lp-PLA2 activity and Lp-PLA2 mass were measured. Lp-PLA2 mRNA expression of PBMC was relatively quantified by real-time fluorescence PCR. Results: Plasma Lp-PLA2 activity was increased in AMI patients compared to UAP patients (395.21±145.91 vs. 328.53±127.03 U/L, p=0.024). Lp-PLA2 mass of AMI patients was also higher than UAP patients (136.43±45.46 vs. 119.16±44.19 ng/mL, p=0.093), while PBMC mRNA expression was not statistically different [1.07 (0.74, 1.57) vs. 0.88(0.49, 1.99), p=0.453]. Comparing Lp-PLA2 mRNA by groups, Lp-PLA2 mRNA level was higher in male ACS patients and smoking ACS patients (p=0.008, p=0.048, respectively). Multivariate logistic regression analysis showed that Lp-PLA2 activity was an AMI risk predictor (OR=5.224, 95% CI 1.687-16.181, p=0.004), after smoking, systolic blood pressure, diabetes and hyperlipidemia were adjusted. Recurrent ACS patients were older (p=0.035), but they showed lower levels of Lp-PLA2 mass and Lp-PLA2 activity (p=0.014, p=0.045, respectively), compared to primary ACS patients. Conclusion: Smoking may be an important regulatory factor for Lp-PLA2 mRNA expression in PBMC. Among three Lp-PLA2 indexes, Lp-PLA2 activity was the best marker indicating AMI risk, while Lp-PLA2 mass maybe play better role as a predictor in avoiding ACS recurrence.
Michelle Coopmans, Heleen Sonneveld, Thomas Berendes
Published: 28 September 2021
Surgical Case Reports, Volume 2021, pp 1-5; https://doi.org/10.31487/j.scr.2021.09.10

Abstract:
Background: Chronic lateral epicondylitis can be a severe disabling condition. There is still lack of consensus on best treatment, as no single intervention has been proven to be superior regarding pain relief and improvement of function. Due to the self-limiting nature of this elbow condition, we are looking for a fast and safe treatment method to break through this pattern of pain and loss of elbow function. Autologous blood injection therapy by means of an automatic injection system, can be a promising new treatment option for this group of patients suffering from chronic lateral epicondylitis. In this study, we evaluated the short-term results of autologous blood injection therapy in a standardized way by using an automatic injection system (=ITEC device) for the treatment of chronic lateral epicondylitis. Methods: A total of 141 patients with chronic lateral epicondylitis (88 female, 53 male) were enrolled in this clinical treatment evaluation being treated with the ITEC device. The mean age of the patients was 50.0 years (19 years-73 years). Numeric rating scale (NRS) and a patient reported outcome measurement tool (Oxford Elbow Score (OES)) were measured at baseline, six weeks and three months follow-up. Results: Pain (NRS, OES) and elbow function / quality of life (OES) were significantly improved within 6 weeks after ITEC treatment. This improvement in NRS and OES sustained during the 3 months follow-up period. Conclusion: Autologous blood injection therapy by means of a new automatic injection system (ITEC device) is a safe and effective treatment method for patients with chronic lateral epicondylitis. More research is necessary to see if this effectiveness sustains in the long-term follow-up.
Jason C. O’Connor, Grace A. Porter
Published: 25 September 2021
Neurology and Neurobiology, Volume 2021, pp 1-10; https://doi.org/10.31487/j.nnb.2021.03.03

Abstract:
Chronic stress is a well-known risk factor in major depressive disorder and disrupts the kynurenine and serotonin pathways of tryptophan metabolism. Here, we characterize the temporal central and peripheral changes in tryptophan metabolism and concomitant depressive-like behavioural phenotype induced during the progression of chronic unpredictable stress (CUS). Mice were exposed to 0, 10, 20, or 30 days of CUS followed by a panel of behavioural assays to determine depressive-like phenotypes. Immediately after behavioural testing, plasma and brain tissue were collected for metabolic analysis. While anhedonia-like and anxiety-like behaviours were unaffected by stress, nesting behaviour and cognitive deficits became apparent in response to CUS exposure. While CUS caused a transient reduction in circulating quinolinic acid, no other tryptophan metabolites significantly changed in response to CUS. In the brain, tryptophan, kynurenine, picolinic acid, and 5-hydroxyindoleacetic acid concentrations were significantly elevated in CUS-exposed mice compared with non-stress control animals, while kynurenic acid, xanthurenic acid, and serotonin decreased in CUS-exposed mice. Metabolic turnover of serotonin to the major metabolite 5-hydroxyindoleacetic acid was markedly increased in response to CUS. These results suggest that CUS impairs hippocampal-dependent working memory and enhances nascent nesting behaviour in C57BL/6J male mice, and these behaviours are associated with increased brain kynurenine pathway metabolism leading to accumulation of picolinic acid and a significant reduction in serotonin levels.
Rosita Bihariesingh, Pieter Voigt, Rakesh Bansie
International Journal of Surgical Case Reports, Volume 2021, pp 1-3; https://doi.org/10.31487/j.ijscr.2021.02.01

Abstract:
The availability of centrifugal cell savers supports intraoperative cell salvage and thereby reduces the need for allogeneic red blood cell transfusion. Use of these devices, however, is limited to the operating room, forcing a switch to allogeneic products in the post-operative setting. Here we present a case of massive post-operative bleeding due to severe coagulopathy following CABG. Due to the lack of availability of donor blood products a novel blood filter (HemoClear BV, Zwolle, the Netherlands) was used for post-operative salvage. Because of its accessible use, we believe this salvage device has great clinical value in the poor-resource setting.
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