Background: To evaluate the efficiency and safety of medium power (MP) holmium laser devices in the enucleation of the enlarged prostate (HoLEP) adenomas compared to high power (HP) laser devices. Methods: Based on the device power used, a total of 120 patients were divided randomly into two groups. While patients in Group 1 were treated with a MP device (50 W) at 39.6-W (2.2J / 18Hz ), patients in Group 2 were treated with HP (100W) device at 42W (1.2J / 35Hz). Peri- and postoperative parameters were well evaluated in both groups with an emphasis on enucleation efficiency and hemoglobin decrease in a comparative manner. Results: Peri- and postoperative parameters as well as functional results were similar in the two groups. The median enucleation efficiency (EE) values in Group 1 and Group 2 were 1.15 (IQR: 0.33-2.2) and 1.11 (IQR: 0.4-2.8), respectively (p=0.775). Hemoglobin decrease values in Group 1 and Group 2 were 1.3 (IQR: 0.1-4) and 1.4 (IQR: 0.4-3.1), respectively (p=0.736). Significant improve in the postoperative functional parameters were noted again in both groups. Conclusion: Our results indicate well that similar to the HP laser devices, effective and safe removal of the enlarged prostate adenomas with MP laser devices (50W) is possible without any technical difficulties, even in patients receiving antithrombotic therapy.
Guillain–Barre’ syndrome (GBS) is an acute inflammatory and immune-mediated demyelinating disease of peripheral nervous system (PNS). Macrophages playing a central role in its animal model, experimental autoimmune neuritis (EAN) has been well-accepted. Additionally, NF-κB inhibitors has been used to treat cancers and showed beneficial effects. Here we investigated the therapeutic effect of M2 macrophage and NF-κB pathway is correlated with macrophages activation in experimental autoimmune neuritis (EAN) in C57BL/6 mice. We demonstrated that M2 macrophage transfusion can alleviate the clinical symptoms of EAN by reducing the proportion of M1 macrophage in the peak period, inhibiting the phosphorylation of NF-κB p65. The NF-κB inhibitor (BAY-11-7082) could alleviate the clinical symptoms of EAN and shorten the duration of symptoms by reducing the proportion of M1 macrophages and the expression of pro-inflammatory cytokines. Consequently, BAY-11-7082 exhibits strong potential as a therapeutic strategy for ameliorating EAN by influencing the balance of M1/M2 macrophages and inflammatory cytokines.
COVID-19 has been associated with both transient and persistent systemic symptoms that do not appear to be a direct consequence of viral infection. The generation of autoantibodies has been proposed as a mechanism to explain these symptoms. To understand this phenomenon in more detail, we investigated the frequency and specificity of clinically relevant autoantibodies in 84 individuals previously infected with SARS-CoV-2, suffering from COVID-19 of varying severity in both the acute and convalescent setting. These were compared with results from 32 individuals who were on ITU for non COVID reasons. We demonstrate a higher frequency of autoantibodies in the COVID-19 ITU group compared with non-COVID-19 ITU disease control patients and that autoantibodies were also found in the serum 3-5 months post COVID-19 infection. Non-COVID patients displayed a diverse pattern of autoantibodies; in contrast, the COVID-19 groups had a more restricted panel of autoantibodies including skin, skeletal muscle and cardiac antibodies. Our results demonstrate that severe COVID-19 induces a pattern of autoantibodies that may correlate with and contribute to the immune pathology associated with the long-term sequelae of infection.
Abstract Aims: Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of Fibrinogen to albumin ratio (FAR) in patients with RPL. Methods: Pregnant women in their first trimester of pregnancy were included in the study and divided in to two groups as RPL patients (n:44) and patients with no previous recurrent miscarriage (n:60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, fibrinogen to albumin ratio (FAR), neutrophil to lymphocyte ratio (NLR), platelet count, main platelet volume (MPV), and red cell distribution width (RDW) values) were compared between the RPL group and the control group. Results: The groups were determined to be statistically different in regards to gravidity and parity (p<0.05). The difference between the groups was statistically different in regards to fibrinogen (mg/dl), albumin (g/dl), FAR (%), NLR (%), RDW-coefficient of variation (CV) (%), RDW-standard deviation (SD) (fL), and platelet counts (10-3/ uL). However, MPV (fL) and D-dimer (ug/L) levels were similar in both groups. The receiver operating characteristic (ROC) curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL. Conclusion: Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.
In this case report we describe how to recycle the Left Internal Thoracic Artery (LITA) when misused but not damaged. 8 years after a Left Anterior Small Thoracotomy followed by LAD stenting for STEMI in 1st post-operative day, a 67 years old woman had a NSTEMI with angiographic evidence of intra-stent re-stenosis with a perfectly patent LITA, harvested only from the 4th to the 6th intercostal space. During redo surgery, LITA was harvested as a pedicle from the anastomosis to the 4th intercostal space and primarily from the 1st to the 4th intercostal space. Special attention was paid at the level of the 4th intercostal space where the vessel was stuck to the sternum: a 15 blade was used being scissors or cautery too dangerous. At the end of harvesting, the LITA was full-length available for a new coronary anastomosis on LAD, distal to the previous one.
Background: The treatment of complex thoracic aorta pathologies remains a challenge for cardiovascular surgeons. After introducing Frozen Elephant Trunk (FET), a significant evolution of surgical techniques has been achieved. The present meta-analysis aimed to assess the efficacy of FET in acute type A aortic dissection (ATAAD) and the effect of circulatory arrest time on post-operative neurologic outcomes. Methods: A standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses search was conducted for all observational studies of patients diagnosed with ATAAD undergoing total arch replacement with FET reporting in-hospital mortality, bleeding, and neurological outcomes. A random-effect meta-analysis was performed using STATA software (StataCorp, TX, USA). Results: Thirty-five studies were eligible for the present meta-analysis, including 3211 patients with ATAAD who underwent total arch replacement with FET. The pooled estimate for in-hospital mortality, postoperative stroke, and spinal cord injury were 7% (95% CI 5 – 9; I2 = 68.65%), 5% (95% CI 4 – 7; I2 = 63.93%), and 3% (95% CI 2 – 4; I2 = 19.56%), respectively. Univariate meta-regression revealed that with increasing the duration of hypothermic circulatory arrest time, the effect sizes for postoperative stroke and SCI enhances. Conclusions: It seems that employing the FET procedure for acute type A dissection is associated with acceptable neurologic outcomes and a similar mortality rate comparing with other aorta pathologies. Besides, increasing hypothermic circulation arrest time appears to be a significant predictor of adverse neurologic outcomes after FET.
Context: Multisystem Inflammatory Syndrome in Children (MISC) is a newly and rising condition, particularly in SARS-CoV-2 high transmission communities. Objective: Analyze current literature and reported cases of MISC, concerning its clinical spectrum, complications associated, therapeutic strategies and distinguishing features of other clinical syndromes. Data Sources: Extensive literature research was performed in MEDLINE (trough PubMed), Scopus and Web of Science from December 2019 to December 2020.Study Selection: First analysis included all article titles and abstracts screening to identify relevant studies and second analysis included a full text screening of previous selected studies. Eligibility was assessed independently by two authors and disagreements were resolved by discussion and consensus. Data Extraction: Data were extracted on MISC definition, demographic data, clinical features, diagnostic tests, laboratory analysis andimaging, therapeutical approach and outcomes. Results: Common symptoms included: gastrointestinal (70%), rash (57%) and cardiovascular (52% with shock). Notable differences with Kawasaki Disease were identified including age, clinical presentation and cardiac involvement. 30% presented positive SARS-CoV-2 2 reverse transcription polymerase chain reaction and 51% positive serologies. 62% received intravenous immunoglobulin and 42% glucocorticoids. 62% required intensive care, 21 children died (<2%). Severe presentations were associated with neurological symptoms, hepatitis and acute kidney injury. Limitations: As a recently documented disease, there was limited prospective and follow-up studies, therefore disregarding long-term sequelae and prognosis. Conclusions: MISC raises concern on its severe cardiac involvement at presentation, with frequent intensive care and immunomodulatory therapy need. Short term outcomes seem to be favorable, with cardiac disfunction recovery and low mortality rates.
Introduction: The covid-19 disease is a pandemic threat for humanity’s healthcare system, social, economic, and psychological well-being for both developed and developing nations. In the case of developing nations such as the resource of Ethiopia, however, the key obstacle is to buy the vaccine and administer it to their people.. In the study area, however, the degree of adherence to the covid-19 preventive measure was not well established. The aim of this study is to determine adherence to covid-19 prevention measures in Hossana town. Methods: From 3 to 29 January 2021, a community-based cross-sectional study was conducted among individuals living in the Hosanna town. We used a sample size of 384. The sample size was distributed to all 8 kebeles in proportion to the size of the households contained in each kebele in the town of Hossana. Systematic sampling methods were used and both descriptive and advanced analysis, data was entered into Epi-data and exported to SPSS. Binary logistic regression was used to identify variables associated with adherence to preventive measures for covid-19. Result: 50.4% of the study participants had good adherence with the COVID-19 preventive measures. 145 (38.5%) of all respondents had poor knowledge on COVID-19 preventive measures and 40.3 % had poor COVID-19 transmission methods knowledge. Age [AOR: 0.34; 95 % CI (0.131-0.912)], educational status [AOR: 0.32; 95% CI (0.165-0.632)], marital status [AOR: 2; % CI (1.191-3.803)], family size [AOR: 2.4; % CI (1.322-4.366)]] and covid-19 complication [AOR: 0.49: 95% CI (0.242-0.979)]] were significantly associated with covid-19 prevention measurement adherence in multivariate analysis. Conclusion: This study found that approximately half of the participants had poor adherence to COVID-19 preventive measures. Factors associated with covid-19 preventive measures were age, educational age, marital status, family size, and heard about complication of COVID-19 were associated with preventive measures.
Objective: To evaluate the accuracy of radiological staging, especially renal venous and perirenal fat invasion, in renal cell carcinoma (RCC). Material & Methods: Data of 4823 renal tumor patients from Renal Tumor Database of Association of Uro-oncology in Turkey were evaluated. Of 4823 patients, 3309 RCC patients had complete radiological and histopathological data were included to this study. The Pearson Chi-squared test (χ2) was used to compare radiological and histopathological stages. Results: The mean (SD) age of 3309 patients was 58 (12.3). Preoperative radiological imaging was performed using computed tomography (CT) (n=2510, 75.8%) or magnetic resonance imaging (MRI) (n=799, 24.2%). There was a substantial concordance between radiological and pathological staging (к=0.52, p<0.001). Sensitivities of radiological staging in stage I, II, III and IV were 90.7%, 67.3%, 27.7% and 64.2%, respectively. The sensitivity in stage III was lower than the other stages. Sub-analysis of stage IIIa cases revealed that, for perirenal fat invasion and renal vein invasion, sensitivity values were 15.4% and 11.3%, respectively. Conclusions: There was a substantial concordance between radiological (CT and/or MRI) and pathological T staging in RCC. However, this is not true for T3 cases. Sensitivity of preoperative radiological imaging in patients with pT3a tumors is insufficient and lower than the other stages. Consequently, preoperative imaging in patients with T3 RCC has to be improved, in order to better inform the patients regarding prognosis of their disease.
Background: Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy has been established as a novel treatment approach for peritoneal sarcomatosis. Despite promising clinical reports, there is still a lack of knowledge regarding optimal drug usage and local effects. Therefore, we intended to establish a murine animal model for further evaluation. Procedure: Alveolar rhabdomyosarcoma cells were xenotransplanted into NOD/LtSz-scid IL2Rγnullmice (n=100). The mice received a continuous intraperitoneal lavage with isotonic saline solution as control- or with cisplatin (30 or 60 mg/m2) as treatment group for 60 minutes at 37 or 42 °C (6 subgroups, each n=16). Tumor spread was documented by an adapted peritoneal cancer index and MRI (n=4). Tumor and tissue samples, harvested at the end of the perfusion, were evaluated regarding morphology, proliferation and apoptosis (H&E-, Ki-67-, Cleaved Caspase 3-staining, TUNEL-assay). Results: Extensive peritoneal sarcomatosis in over 91% of the cases was observed. HIPEC was feasible without acute side effects. Ki-67 staining revealed concentration- or temperature-dependent effects of cisplatin-based HIPEC on the tumors. While Cleaved Caspase-3 showed only sporadic apoptotic effects. TUNEL-assay detected concentration- or temperature-dependent apoptotic effects at the outer tumor surface. MRI scans confirmed the observed tumor dissemination. Conclusion: This is the first animal model for evaluation of HIPEC in pediatric RMS in mice. Cisplatin-based HIPEC had early effects on the proliferation whereas circumscribed apoptotic effects could be detected at the tumor surface. This model allows further insights on the possible efficiency of HIPEC in RMS. Further studies using other drug combinations and treatment will follow.
We thank Shixiong Wei et al for their interest in our technical paper on Robotic Septal myectomy for HOCM and their letter to the editor. Their technique of using the Computed Tomography Angiography (CTA) along with 3D Printing technology for the better delineation of the anatomy of HOCM has been an evolving way to approach the problem. As they have mentioned in their letter, we used cardiac magnetic resonance imaging (MRI) predominantly for all our patients who undergo septal myectomy. Using 3D printing technology augmenting CTA or MRI can certainly augment the surgical planning in complex patients. In their case report, Wei et al have shaved off most of the subvalvular tissue along with the mitral valve. Removal of the entire mitral valve definitely would have enhanced the exposure to the mid-ventricular cavity and the apex for their thoracoscopic approach. It will be interesting to know whether they tried to repair the valve before replacement. Our technique of Robotic mitral valve repair, septal myectomy, and particularly papillary muscle re-orientation tries to preserve the sub-valvular apparatus even after completely relieving the mid-cavitary obstruction and this may provide better ventricular re-modeling. We congratulate them on providing a successful surgical option to this complex subset of patients using novel evolving technology and meticulous surgical planning.
The most effective way to prevent and control infectious disease outbreak is through vaccines. The increasing use of vaccines has elevated the need to establish new manufacturing strategies. One of the major approaches is cell-based production, which creates a need for high cell density to enable higher cell production levels. This has led to development of the technology of cell carriers, including micro and macro cell carriers. To follow the production process, quantifying the number of cells on these carriers is required, as well as the tracking of their viability and proliferation. However, owing to various carriers’ unique structures, tracking the cell’s is challenging using current traditional assays that were originally developed for monolayers of adherent cells. The current “gold standard” method is counting cell nuclei, separating cells from the carrier, staining with crystal violet and visually counting under a microscope. This method is tedious and counts both live and dead cells. A few other techniques were developed but were specific to the carrier type and involved specialized equipment. In this study, we describe a broadly ranging method for counting cells on carriers that was developed and employed as part of the production of a vaccine for use in the SARS-CoV-2 pandemic. The method is based on the Alamar blue dye, a well-known, common marker for cell activity, and was found to be successful in tracking cell adsorption, cell growth and viability on carriers. No separation of the cells from the carriers is needed, nor is any specialized equipment; the method is simple and rapid, and provides comprehensive details necessary for process control of viral vaccine production in cells. This method can be easily implemented in any of a number of cell-based processes and other unique platforms for measuring growth of encapsulated cells.
Background: Standard dose seasonal influenza vaccines often produce modest immunogenic responses in adults ≥65 years old. MF59 is intended to elicit a greater magnitude and increased breadth of immune response. Objective: To determine the effectiveness of seasonal MF59-adjuvanted trivalent/quadrivalent influenza vaccine (aTIV/aQIV) relative to no vaccination or vaccination with standard or high dose egg-based influenza vaccines among people ≥65 years old. Methods: Cochrane methodological standards and PRISMA-P guidelines were followed. Real-world evidence from non-interventional studies published in peer reviewed journals and grey literature from 1997 through to July 15, 2020, including cluster-randomized trials, were eligible. Two reviewers independently extracted data and risk of bias was assessed using the ROBINS-I tool. Results: Twenty-one studies conducted during the 2006/07-2019/20 influenza seasons were included in the qualitative review; 16 in the meta-analyses. Meta-analysis of test-negative studies found that aTIV reduced medical encounters due to lab-confirmed influenza with pooled estimates of 40.7% (95% CI: 21.9, 54.9; I2=0%) for general practitioner visits and 58.5% (40.7, 70.9; I2=52.9%) for hospitalized patients. The pooled estimate of VE from case-control studies was 51.3% (39.1, 61.1; I2=0%) against influenza- or pneumonia-related hospitalization. The pooled estimates for the relative VE of aTIV for the prevention of influenza related medical encounters were 13.9% (4.2, 23.5; I2=95.9%) compared with TIV, 13.7% (3.1, 24.2; I2=98.8%) compared with QIV, and 2.8% (-2.9, 8.5; I2=94.5%) compared with HD TIV. Conclusions: Among adults ≥65 years aTIV demonstrated significant absolute VE, improved relative VE compared to non-adjuvanted standard-dose TIV/QIV, and comparable relative VE to high-dose TIV.
This report describes a case of 45 years old male patient who tested positive for COVID-19 presented to the emergency department on March 2021 complaining of fever, cough, runny nose, and shortness of breath. The patient denied any history of nausea or diarrhea who has eventually developed favipiravir-induced nephrotoxicity.
Background: Chemokines are important mediators in immune cell recruitment, contributing to allergy development. However, extensive studies of chemokines in the circulation in relation to the presence and development of allergic diseases remain scarce. Our aim was to investigate associations of circulating allergy-related chemokines with development of asthma and sensitisation cross-sectionally and longitudinally in a population-based cohort. Methods: The chemokines CCL17, CCL22, CXCL10, CXCL11 and CCL18 were measured in plasma samples from children in the Manchester Asthma and Allergy Study. Samples were available from cord blood at birth (n=376), age 1 (n=195) and 8 years (n=334). Cross-sectional and longitudinal association analyses were performed in relation to asthma and allergic sensitisation, as well as allergic phenotype clusters previously derived using machine learning in the same study population. Results: In children with asthma and/or allergic sensitisation, CCL18 levels were consistently elevated at ages 1 and/or 8 years. In a longitudinal model including information on asthma from 4 time-points (ages 5, 8, 11 and 16 years), we observed a significant association between increasing CCL18 levels at age 1 and a higher risk of asthma from early school age to adolescence (OR=2.9, 95% CI 1.1-7.6, p=0.028). We observed similar associations in longitudinal models for allergic sensitisation. Asthma later in life was preceded by increased CXCL10 levels after birth, and decreased CXCL11 levels at birth. Conclusion: Elevated CCL18 levels throughout childhood precede the development of asthma and allergic sensitisation. The Th1-associated chemokines CXCL10 and CXCL11 also associated with development of both outcomes, with differential temporal effects.