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International Immunopharmacology Jun 2024Until 2021, colon cancer was a leading cancer globally. Early detection improves outcomes; however, advanced cases still having poor prognosis. Therefore, an...
BACKGROUND
Until 2021, colon cancer was a leading cancer globally. Early detection improves outcomes; however, advanced cases still having poor prognosis. Therefore, an understanding of associated molecular mechanisms is crucial for developing new preventive and therapeutic strategies for colon cancer.
METHODS
The TCGA database was analyzed to assess melanocortin 1receptor (MC1R) expression in colon cancer and its link with patient prognosis. Further, models and diverse experimental techniques were employed to investigate the impact of MC1R on colon cancer progression and its underlying mechanism was elucidated.
RESULTS
In a follow-up study of clinical patients, the important role of MC1R was identified in the development of colon cancer. First, MC1R was expressed more highly in colon tumor tissues than in adjacent tissues. In addition, MC1R was associated with colon cancer prognosis, and higher expression of MC1R tended to predict a worse prognosis. This conclusion was verified in MC1R mice, which showed a greater resistance to tumor growth than wild-type mice, as expected. Further investigation revealed a significant change in the portion of Tregs in MC1R mice, while the portion of CD4 + and CD8 + T cells remained unchanged. The in vitro experiments revealed a weaker ability of the MC1R T cells to differentiate into Tregs. Previous studies report that the functional integrity of Tregs is interwoven with cellular metabolism. Therefore, MC1R was deduced to regulate the differentiation of Tregs by reprogramming the metabolism. As expected, MC1R T cells exhibited weaker mitochondrial function and a lower aerobic oxidation capacity. Concurrently, the MC1R T cells had stronger limiting effects on colon cancer cells. According to these results, the MC1R inhibitor was hypothesized as a potential therapeutic agent to suppress colon cancer. The results showed that upon MC1R suppression, the tumors in the mice developed more slowly, and the mice survived longer, potentially providing a novel strategy to treat clinical colon cancer.
CONCLUSION
By regulating Tregs differentiation, MC1R overexpression in colon cancer correlates with poor prognosis, while MC1R inhibition shows potential as a therapeutic approach to slow tumor growth and enhance survival.
PubMed: 38917522
DOI: 10.1016/j.intimp.2024.112546 -
PloS One 2024Births at advanced maternal ages (≥ 35 years) are increasing. This has been associated with a higher incidence of placenta previa, which increases bleeding risk....
BACKGROUND
Births at advanced maternal ages (≥ 35 years) are increasing. This has been associated with a higher incidence of placenta previa, which increases bleeding risk. Hybrid operating rooms, designed to accommodate interventions and cesarean sections, are becoming more prominent because of their dual capabilities and benefits. However, they have been associated with increased postoperative hypothermia in pediatric settings; moreover, this has not been studied in pregnant women with placenta previa.
METHODS
This retrospective cohort study included pregnant women diagnosed with placenta previa who underwent elective cesarean section under general anesthesia between May 2019 and 2023. The patients were categorized according to the operating room type. The primary outcome was to determine whether the hybrid operating room is a risk factor for immediate postoperative hypothermia, defined as a tympanic membrane temperature below 36.0°C. The secondary outcomes were the effects of immediate postoperative hypothermia on the durations of postanesthetic care unit and postoperative hospital stays and incidence of complications.
RESULTS
Immediate postoperative hypothermia (tympanic membrane temperature < 36.0°C) was more prevalent in the hybrid than in the standard operating room group (20% vs. 36.6%, p = 0.033), with a relative risk of 2.86 (95% confidence interval 1.24-6.64, p < 0.001). Patients undergoing surgery in the hybrid operating room who experienced immediate postoperative hypothermia stayed longer in the postanesthetic care unit (26 min vs. 40 min, p < 0.001) and in the hospital after surgery (4 days; range 3-5 vs. 4 days; range 4-11, p = 0.021). However, the complication rates of both groups were not significantly different (11.3% vs 7.3%, p = 0.743).
CONCLUSION
Hybrid operating rooms may increase the risk of postoperative hypothermia. Postoperative hypothermia is associated with prolonged postanesthetic care unit and hospital stays. Preventing hypothermia in patients in hybrid operating rooms is of utmost importance.
Topics: Humans; Female; Pregnancy; Hypothermia; Retrospective Studies; Operating Rooms; Adult; Postoperative Complications; Cesarean Section; Risk Factors; Placenta Previa; Anesthesia, General
PubMed: 38917215
DOI: 10.1371/journal.pone.0305951 -
PloS One 2024This study developed and validated a surgical instrument motion measurement system for skill evaluation during practical laparoscopic surgery training. Owing to the...
This study developed and validated a surgical instrument motion measurement system for skill evaluation during practical laparoscopic surgery training. Owing to the various advantages of laparoscopic surgery including minimal invasiveness, this technique has been widely used. However, expert surgeons have insufficient time for providing training to beginners due to the shortage of surgeons and limited working hours. Skill transfer efficiency has to be improved for which there is an urgent need to develop objective surgical skill evaluation methods. Therefore, a simple motion capture-based surgical instrument motion measurement system that could be easily installed in an operating room for skill assessment during practical surgical training was developed. The tip positions and orientations of the instruments were calculated based on the marker positions attached to the root of the instrument. Because the patterns of these markers are individual, this system can track multiple instruments simultaneously and detect exchanges. However due to the many obstacles in the operating room, the measurement data included noise and outliers. In this study, the effect of this decrease in measurement accuracy on feature calculation was determined. Accuracy verification experiments were conducted during wet-lab training to demonstrate the capability of this system to measure the motion of surgical instruments with practical accuracy. A surgical training experiment on a cadaver was conducted, and the motions of six surgical instruments were measured in 36 cases of laparoscopic radical nephrectomy. Outlier removal and smoothing methods were also developed and applied to remove the noise and outliers in the obtained data. The questionnaire survey conducted during the experiment confirmed that the measurement system did not interfere with the surgical operation. Thus, the proposed system was capable of making reliable measurements with minimal impact on surgery. The system will facilitate surgical education by enabling the evaluation of skill transfer of surgical skills.
Topics: Laparoscopy; Humans; Clinical Competence; Surgical Instruments; Motion; Cadaver; Nephrectomy
PubMed: 38917181
DOI: 10.1371/journal.pone.0305693 -
Aesthetic Surgery Journal. Open Forum 2024Minimally invasive and consistent skin redraping following liposuction remains an elusive goal. With the application of Renuvion (Apyx Medical, Clearwater, FL), helium...
BACKGROUND
Minimally invasive and consistent skin redraping following liposuction remains an elusive goal. With the application of Renuvion (Apyx Medical, Clearwater, FL), helium induced cold atmospheric plasma provides coagulation, collagen contraction, and subsequent skin tightening, making this elusive goal attainable.
OBJECTIVES
The objective of this study is to evaluate energy settings, and the safety profile of Renuvion in an effort to achieve optimal cosmesis through the improvement of skin laxity.
METHODS
A retrospective review at a single site evaluated cases of Renuvion between March 2020 and May 2022. Energy settings, use of concomitant VASER (Solta Medical, Bothwell, WA) liposuction frequency, and adverse events were analyzed.
RESULTS
In total, 180 patients were evaluated, of whom 135 (75%) underwent concomitant VASER liposuction. Renuvion was used on the abdomen (47.8%), thighs (45.6%), arms (27.2%), submental region (25%), hip rolls (21.2%), and back (19.4%). Among the entire cohort, there were a total of 24 (13.3%) complications. The complications consisted of 3 (12.5%) hematomas, 1 (4.2%) burn, 6 (25%) persistent skin laxity with 2 returned operating room (OR) treatments, 4 (16.7%) seromas, 9 (37.5%) postoperative lymphedema that self-resolved, and 1 (4.2%) self-limited neuralgia. There were no complications that required an immediate return to the OR.
CONCLUSIONS
Renuvion utilization with or without VASER has a relatively high complication rate-with minor complications as the most common-relatively safe barring proper patient selection, which can be mitigated with proper patient selection.
PubMed: 38915442
DOI: 10.1093/asjof/ojae041 -
The American Journal of Managed Care Jun 2024The number of anterior cruciate ligament reconstruction (ACL-R) surgeries for adolescent patients has been increasing, and so are the costs for medical care services and...
OBJECTIVES
The number of anterior cruciate ligament reconstruction (ACL-R) surgeries for adolescent patients has been increasing, and so are the costs for medical care services and the general cost of living. We proposed a novel economic model assessing the cost associated with adolescent ACL-R over time and how this compared with price measures in the US economy.
STUDY DESIGN
Economic analysis.
METHODS
ACL-R surgeries performed from 2010 to 2022 in a single Level I trauma center were included. The trend of the total charge, charge of anesthesia, and operating room (OR) charge were normalized to 2010 (base year) and compared with the inflation in hospital services, medical care services, and the US economy measured by the Consumer Price Index (CPI). The actual reimbursements-to-charges percentage from the payers was analyzed. Comparing growth rates rather than dollar values circumvented any problematic direct-dollar comparisons across measures.
RESULTS
Analyzing 459 qualified ACL-R cases in patients whose ages ranged from 12 to 18 years, the overall total median charge increased 70%, whereas the General CPI, Medical CPI, and Hospital CPI increased 35%, 41%, and 64%, respectively. The anesthesia and OR charges increased 52% and 92%, respectively. The annual reimbursements-to-charges percentage hovered steadily beneath 50%. All inflation measures rose sharply after 2019.
CONCLUSIONS
The rising cost of adolescent ACL-R has been outpacing the inflation in the cost of medical services and the general economy in the US. The COVID-19 pandemic and market rigidity in medical services may have impacted these trends. Optimizing OR time usage may mitigate the rising cost.
Topics: Humans; Adolescent; Anterior Cruciate Ligament Reconstruction; Female; Male; United States; Child; Models, Economic; Anterior Cruciate Ligament Injuries; Health Care Costs
PubMed: 38912932
DOI: 10.37765/ajmc.2024.89565 -
Journal of Surgical Case Reports Jun 2024A left main coronary artery aneurysm is a rare anomaly. There are no standardized treatment guidelines given the infrequency of reported cases. A 70-year-old African...
A left main coronary artery aneurysm is a rare anomaly. There are no standardized treatment guidelines given the infrequency of reported cases. A 70-year-old African American female with an enlarging distal left main coronary artery aneurysm was taken to the operating room for surgical intervention. The patient underwent a successful open surgical repair of the aneurysm with reconstruction of the distal left main using a radial artery patch. No coronary bypasses were necessary. Aneurysm ligation with concomitant coronary artery bypass grafting is commonly reported but reconstruction may be preferable when the anatomy is suitable. Preservation of nonobstructed native coronary artery circulation should also be considered to avoid life-long graft dependency.
PubMed: 38912431
DOI: 10.1093/jscr/rjae423 -
Annals of Surgery Open : Perspectives... Jun 2024The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room...
OBJECTIVES
The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites.
BACKGROUND
The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC.
METHODS
A pre-post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites' health surveillance systems.
DATA ANALYSIS
Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks.
SETTING
The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital.
ANTICIPATED IMPACT
We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.
PubMed: 38911631
DOI: 10.1097/AS9.0000000000000436 -
Gynecology and Minimally Invasive... 2024The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic...
OBJECTIVES
The objectives of this study were to evaluate the visual analog scale (VAS) score in patients receiving port-site bupivacaine infiltration in gynecological laparoscopic surgeries and to compare it with those receiving placebo and to evaluate the additional analgesic requirement in the first 24 h after surgery.
MATERIALS AND METHODS
A prospective interventional study was conducted on 60 women scheduled for benign gynecological laparoscopic surgeries. Patients were randomized into two groups using an alternative sequential method of allocation. Approval from the Institute's Ethics Committee was sought. Informed written consent was taken from all the patients. All laparoscopic surgeries were performed under general anesthesia. Double-blinding was done. A VAS with a 10 cm vertical score ranging from "no pain" to "worst possible pain" was used to assess the postoperative pain when the patient awakened in the operating room (2 h after surgery), then after 6 and 24 h. The primary outcome measured was pain perception by the patient (as VAS scores), and the secondary outcome was the need for additional analgesia.
RESULTS
Comparison of both groups with the VAS score shows > 0.001, i.e., nonsignificant in all the groups. Additional analgesics were required in 56% of the patients in the intervention group and 60% of the patients in the control group; however, 44% and 40% of the patients from the intervention and control groups, respectively, do not require any additional analgesic in the postoperative period.
CONCLUSION
The local infiltration of bupivacaine does not significantly reduce the port-site postoperative pain in gynecological laparoscopic surgeries.
PubMed: 38911315
DOI: 10.4103/gmit.gmit_77_22 -
Risk Management and Healthcare Policy 2024Patient safety incidents in the operating room require special attention because they can cause catastrophic and irreversible conditions in patients. Although patient...
PURPOSE
Patient safety incidents in the operating room require special attention because they can cause catastrophic and irreversible conditions in patients. Although patient safety incidents have different characteristics, there may be similarities and patterns of risk factors that may be common. Therefore, this study analyzed factors associated with the PSIs by analyzing data from the Korean Patient Safety Reports from 2017 to 2019.
METHODS
The "Patient Safety Incidents Data from 2017 to 2021" systematically collected by the Korea Institute for Healthcare Accreditation, include patient safety incident reports from medical institutions. Data on 1140 patient safety incidents in the operating room were analyzed. They included patients' gender and age, Hospital size, Incident seasons, incident time, Incident reporter, incident type, Medical department, and Incident severity. The Incident severity was analyzed by dividing it into three stages: near miss, adverse event, sentinel event, which are applied by domestic medical institutions.
RESULTS
The highest number of OR patient safety incidents were related to surgery and anesthesia. On analyzing the probability of adverse events based on near misses, the significant variables were patient gender, incident reporter, incident type, and Medical department. Additionally, the factors that were likely to precipitate sentinel events based on near misses were patient gender, incident time, reporter, and incident type.
CONCLUSION
To prevent sentinel events in Patient safety incidents, female and during night shifts are required to pay close attention. Moreover, it is necessary to establish a patient safety reporting system in which not only all medical personnel, but also patients, generally, can actively participate in patient safety activities.
PubMed: 38910898
DOI: 10.2147/RMHP.S462485 -
Medicine Jun 2024Extracorporeal membrane oxygenation (ECMO) is used for severe cardiopulmonary failure, with veno-arterial ECMO for cardiogenic shock and veno-venous ECMO for acute... (Observational Study)
Observational Study
BACKGROUND
Extracorporeal membrane oxygenation (ECMO) is used for severe cardiopulmonary failure, with veno-arterial ECMO for cardiogenic shock and veno-venous ECMO for acute respiratory failure. ECMO's application has expanded to ICUs, emergency departments, and operating rooms. ECMO patients are at high risk for complications, including acute kidney injury (AKI), often requiring renal replacement therapy (RRT), posing significant management challenges.
METHODS
From August 2015 to June 2022, 120 patients were cured with veno-venous ECMO (n = 60) or veno-arterial ECMO (VA-ECMO, n = 60) combined with CRRT in our hospital. In the control group (n = 60), the input end (arterial end) of CRRT was connected to the ECMO oxygenator. The reinfusion end (venous end) of CRRT was connected to the oxygenator of ECMO for CRRT + ECMO treatment. In the experimental group (n = 60), the input end (arterial end) of CRRT was connected to the oxygenator of ECMO, and an additional pressure regulating device was installed on the connection of the 2 lines. The observation indexes including clinical therapeutic effect, clinical therapeutic effect, the incidence of complications, and the incidence of complications were compared.
RESULTS
There was a notable decrease in serum creatinine, and the differences in blood urea nitrogen, procalcitonin, and C-reactive protein after operation were statistically significant (P < .05). The filter use time in the study group was notably longer (P < .01). There exhibited no remarkable difference in the incidences of bleeding, thrombosis, numbness of hands and feet, metabolic alkalosis, disseminated intravascular coagulation, organ dysfunction syndrome, hyperbilirubinemia, and infection.
CONCLUSION
This study demonstrates that additional pressure regulation devices are installed at the line connection between the CRRT input end and the CRRT return end to ensure that the flow rate of ECMO does not affect the CRRT treatment. ECMO and CRRT provide a safe pressure range so that the ECMO line can be safely connected to the CRRT machine at physiological pressure, reducing the occurrence of complications related to CRRT machine interruption and improving the efficiency of CRRT without affecting the efficiency of ECMO, ensuring patient safety.
Topics: Humans; Extracorporeal Membrane Oxygenation; Female; Male; Middle Aged; Acute Kidney Injury; Renal Replacement Therapy; Aged; Incidence; Adult
PubMed: 38905421
DOI: 10.1097/MD.0000000000038580