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World Journal of Surgical Oncology Jul 2023Pancreatic follicular dendritic cell sarcoma (FDCS) is an exceptionally rare and low-to-moderate malignancy, with only seven reported cases to date. Clinical diagnosis...
INTRODUCTION
Pancreatic follicular dendritic cell sarcoma (FDCS) is an exceptionally rare and low-to-moderate malignancy, with only seven reported cases to date. Clinical diagnosis of FDCS is challenging due to the lack of distinct biological and radiographic features.
CASE PRESENTATION
A 67-year-old woman presented to the hospital with a 4-day history of severe abdominal pain. Imaging studies (CT and MRI) revealed a large cystic mass located at the tail of the pancreas, which was suspected to be myeloid sarcoma (MS) based on EUS and CT-guided pancreatic puncture. Postoperative pathology and immunohistochemistry confirmed the diagnosis of pancreatic FDCS. After the diagnosis was confirmed, the patient received postoperative chemotherapy with the CHOP regimen. At 11 months of follow-up, there was no evidence of recurrence. Seven published cases have been reviewed to comprehensively summarize the clinical characteristics, diagnosis, and treatment options of FDCS.
CONCLUSION
While imaging can be useful in detecting pancreatic FDCS, it should be interpreted with caution as it can be challenging to differentiate from other pancreatic tumors. Pathology and immunohistochemistry are considered the gold standard for diagnosis, with CD21, CD23, and CD35 being specific tumor cell markers. However, preoperative diagnosis of pancreatic FDCS remains difficult, and the pancreatic puncture may further increase the risk of misdiagnosis. The disease is highly prone to recurrence and metastasis, and surgery is the preferred method for both diagnosis and treatment of localized disease.
Topics: Female; Humans; Aged; Dendritic Cell Sarcoma, Follicular; Pancreas; Pancreatic Neoplasms; Abdominal Pain; Biomarkers, Tumor
PubMed: 37480085
DOI: 10.1186/s12957-023-03115-5 -
Langenbeck's Archives of Surgery Jul 2023Incisional hernia (IH) is the main complication after laparotomy. In an attempt to reduce this complication, mesh techniques and studies in which the closure technique... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Incisional hernia (IH) is the main complication after laparotomy. In an attempt to reduce this complication, mesh techniques and studies in which the closure technique is modified have been proposed. Both types are characterized by comparison with the closure described as standard or conventional: 1 × 1, mass, and continuous closure. For this study, modified closure techniques (MCTs) were considered as those techniques in which an extra suture is placed (reinforced tension line (RTL), retention), the closure point is modified in distance (small bites) or shape (CLDC, Smead Jones, interrupted, Cardiff point) and which aim to reduce these complications. The objective of this network meta-analysis (NMA) was to evaluate the effectiveness of MCTs for reducing the incidence of IH and abdominal wound dehiscence (AWD) to provide objective support for their recommendation.
METHODS
An NMA was performed according to the PRISMA-NMA guidelines. The primary objective was to determine the incidence of IH and AWD, and the secondary objective was to determine the incidence of postoperative complications. Only published clinical trials were included. The risk of bias was analyzed, and the random-effects model was used to determine statistical significance.
RESULTS
Twelve studies comparing 3540 patients were included. The incidence of HI was lower in RTL, retention suture, and small bites, these techniques showed statistical differences with pooled ORs (95% CI) of 0.28 (0.09-0.83), 0.28 (0.13-0.62), and 0.44 (0.31-0.62), respectively. Associated complications, including hematoma, seroma, and postoperative pain, could not be analyzed; however, MCTs did not increase the risk of surgical site infection.
CONCLUSION
Small bites, RTL, and retention sutures decreased the prevalence of IH. RTL and retention suture decreased the prevalence of AWD. RTL was the best technique as it reduced both complications (IH and AWD) and had the best SUCRA and P-scores, and the number needed to treat (NNT) for net effect was 3.
REGISTRATION
This study was prospectively registered in the PROSPERO database under registration number CRD42021231107.
Topics: Humans; Incisional Hernia; Laparotomy; Network Meta-Analysis; Suture Techniques; Abdomen; Abdominal Injuries; Sutures; Abdominal Wound Closure Techniques; Surgical Wound Dehiscence
PubMed: 37418033
DOI: 10.1007/s00423-023-02954-w -
Frontiers in Endocrinology 2023We conducted a systematic review and meta-analysis to investigate the effect of exercise training on body composition outcomes in postmenopausal women. (Meta-Analysis)
Meta-Analysis
INTRODUCTION
We conducted a systematic review and meta-analysis to investigate the effect of exercise training on body composition outcomes in postmenopausal women.
METHODS
PubMed, Web of Science, CINAHL, and Medline were searched to identify the randomized controlled trials which evaluated effect of exercise training versus control in postmenopausal women. Standardized mean differences (SMD), weighted mean differences (WMD) and 95% confidence intervals (95% CIs) were calculated using random effects model.
RESULTS
One hundred and one studies involving 5,697 postmenopausal women were included in the meta-analysis. Results indicated that exercise training effectively increased muscle mass/ volume, muscle and fiber cross-sectional area and fat-free mass, and decreased fat mass, body fat percentage, waist circumference and visceral fat. Furthermore, subgroup analyses results revealed that aerobic and combined training had greater beneficial effects on fat mass outcomes, whereas resistance and combined training had greater beneficial effects on muscle mass outcomes.
DISCUSSION
Overall, our results revealed that exercise training is effective for improving body composition in postmenopausal women. To be specific, aerobic training is effective on fat loss, whereas resistance training is effective on muscle gain. However, combination of aerobic and resistance trainings may be considered a viable strategy to improve body composition in postmenopausal women.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42021283425.
Topics: Humans; Female; Postmenopause; Body Composition; Exercise; Intra-Abdominal Fat; Muscles
PubMed: 37388207
DOI: 10.3389/fendo.2023.1183765 -
La Clinica Terapeutica 2023Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma.
BACKGROUND
Splenosis is the presence of ectopic autotransplantation of splenic tissue in various compartments of the human body, occurring after rupture of the splenic parenchyma.
METHODS
A systematic PubMed and Scopus search was conducted.
RESULTS
The mean age of the patients was 51.7 years. The majority of patients were of female gender. An emergency presentation was noted in 30 out of 85 patients, having abdominal pain as main symptom. The principal reason for splenectomy were traffic accidents. The time span between splenectomy and the initial symptoms ranged between 1 and 57 years. The most frequent symptom at presentation of pelvic splenosis was abdominal pain. Almost a quarter of the included patients were without any symptom. Presence of extrapelvic splenosis was de-scripted in almost half of the included patients. With regards to the type of treatment provided, exploratory laparotomy, laparoscopic surgical exploration / laparoscopy, robotic removal of splenium and watchful waiting, were performed in 35 (41.2%), 32 (37.6%), 3 (3.5%) and 15 (16.3%) patients, respectively. No fatality was reported.
CONCLUSION
Pelvic splenosis is a rare clinical condition. It may mimic several clinical conditions and mislead diagnosis. The clinical history of splenectomy for trauma or different other reasons may es-tablish diagnosis and exclude other morbidities. Excision and complete removal of pelvic splenosis nodules is not always necessary and it depends on the clinical symptomatology. Careful imaging and precise assessment with the assistance of nuclear medicine may lead to correct diagnosis and avoid unnecessary surgical interventions.
Topics: Humans; Female; Middle Aged; Splenosis; Splenectomy; Abdominal Pain; Diagnosis, Differential; Laparotomy
PubMed: 37378510
DOI: 10.7417/CT.2023.2453 -
Complementary Therapies in Medicine Sep 2023This systematic review and meta-analysis aimed to determine the effectiveness of yoga on anthropometry, quality of life, and lipid profiles in patients with obesity and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review and meta-analysis aimed to determine the effectiveness of yoga on anthropometry, quality of life, and lipid profiles in patients with obesity and central obesity.
METHODOLOGY
The Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed (1985-January 2022) and trial registries for relevant randomised clinical trials were used. Relevant and published randomised clinical trials were reviewed and evaluated. The primary outcomes were anthropometry measurements, which were weight, waist circumference, body mass index (BMI), and body fat percentages. The secondary outcomes were changes in quality of life, psychological impact, lipid profile measurement, presence of adverse events, and changes in blood pressure and blood glucose. We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence.
RESULTS
15 studies are included, involving 1161 participants. The analysis performed is based on three comparisons. For the first comparison between yoga and control, yoga reduces the waist circumference (MD -0.84, 95% CI [-5.12 to 3.44]), while there is no difference in body weight, BMI, or body fat percentages. In the second comparison between yoga and calorie restriction, yoga reduces body weight (MD -3.47, 95% CI [-6.20 to -0.74]), while there is no difference in waist circumference, BMI, or body fat percentage. In the third comparison between yoga and exercise, yoga reduces the body weight (MD -7.58, 95% CI [-11.51 to -3.65]), while there is no difference in waist circumference or BMI. For the secondary outcomes, yoga intervention reduces total cholesterol (MD -17.12, 95% CI [-32.24 to -2.00]) and triglycerides (MD -21.75, 95% CI [-38.77 to -4.73]) compared to the control group, but there is no difference compared to the calorie restriction and exercise group. There is no difference in the rest of the outcomes, which are LDL, HDL, quality of life, psychological impact, adverse events, blood pressure, and blood glucose. However, findings are not robust due to a high risk of bias and low-quality evidence.
CONCLUSION
From our review, there were methodological drawbacks and very low to moderate quality of evidence across all comparisons, and hence, it is inconclusive to say that yoga can significantly improve anthropometric parameters. More well-designed trials are needed to confirm and support the beneficial effects of yoga.
Topics: Humans; Yoga; Quality of Life; Obesity, Abdominal; Blood Glucose; Obesity; Body Mass Index; Triglycerides
PubMed: 37356673
DOI: 10.1016/j.ctim.2023.102959 -
Scandinavian Journal of Trauma,... Jun 2023Civilian public mass shootings (CPMSs) are a major public health issue and in recent years several events have occurred worldwide. The aim of this systematic review was... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Civilian public mass shootings (CPMSs) are a major public health issue and in recent years several events have occurred worldwide. The aim of this systematic review was to characterize injuries and mortality after CPMSs focusing on in-hospital management of hemorrhage and vascular injuries.
METHOD
A systematic review of all published literature was undertaken in Medline, Embase and Web of Science January 1st, 1968, to February 22nd, 2021, according to the PRISMA guidelines. Literature was eligible for inclusion if the CPMS included three or more people shot, injured or killed, had vascular injuries or hemorrhage.
RESULTS
The search identified 2884 studies; 34 were eligible for inclusion in the analysis. There were 2039 wounded in 45 CPMS events. The dominating anatomic injury location per event was the extremity followed by abdomen and chest. The median number of operations and operated patients per event was 22 (5-101) and 10.5 (4-138), respectively. A total of 899 deaths were reported with a median mortality rate of 36.1% per event (15.9-71.4%) Thirty-eight percent (13/34) of all studies reported on vascular injuries. Vascular injuries ranged from 8 to 29%; extremity vascular injury the most frequent. Specific vascular injuries included thoracic aorta 18% (42/232), carotid arteries 6% (14/232), and abdominal aorta 5% (12/232). Vascular injuries were involved in 8.3%-10% of all deaths.
CONCLUSION
This systematic review showed an overall high mortality after CPMS with injuries mainly located to the extremities, thorax and abdomen. About one quarter of deaths was related to hemorrhage involving central large vessel injuries. Further understanding of these injuries, and structured and uniform reporting of injuries and treatment protocols may help improve evaluation and management in the future. Level of Evidence Systematic review and meta-analysis, level III.
Topics: Humans; Hemorrhage; Retrospective Studies; Vascular System Injuries; Wounds, Gunshot
PubMed: 37337265
DOI: 10.1186/s13049-023-01093-x -
Ultrasound in Obstetrics & Gynecology :... Oct 2023The primary objective was to perform a systematic review of predictive factors for obstetric anal sphincter injury (OASI) occurrence at first vaginal delivery, with the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The primary objective was to perform a systematic review of predictive factors for obstetric anal sphincter injury (OASI) occurrence at first vaginal delivery, with the diagnosis made by ultrasound (US-OASI). The secondary objective was to report on incidence rates of sonographic anal sphincter (AS) trauma, including trauma that was not clinically reported at childbirth, among the studies providing data for our primary objective.
METHODS
We conducted a systematic search of MEDLINE, EMBASE, Web of Science, CINAHL, The Cochrane Library and ClinicalTrials.gov databases. Both observational cohort studies and interventional trials were eligible for inclusion. Study eligibility was assessed independently by two authors. Random-effects meta-analyses were performed to pool effect estimates from studies reporting on similar predictive factors. Summary odds ratio (OR) or mean difference (MD) is reported with 95% CI. Heterogeneity was assessed using the I statistic. Methodological quality was assessed using the Quality in Prognosis Studies tool.
RESULTS
A total of 2805 records were screened and 21 met the inclusion criteria (16 prospective cohort studies, three retrospective cohort studies and two interventional non-randomized trials). Increasing gestational age at delivery (MD, 0.34 (95% CI, 0.04-0.64) weeks), shorter antepartum perineal body length (MD, -0.60 (95% CI, -1.09 to -0.11) cm), labor augmentation (OR, 1.81 (95% CI, 1.21-2.71)), instrumental delivery (OR, 2.13 (95% CI, 1.13-4.01)), in particular forceps extraction (OR, 3.56 (95% CI, 1.31-9.67)), shoulder dystocia (OR, 12.07 (95% CI, 1.06-137.60)), episiotomy use (OR, 1.85 (95% CI, 1.11-3.06)) and shorter episiotomy length (MD, -0.40 (95% CI, -0.75 to -0.05) cm) were associated with US-OASI. When pooling incidence rates, 26% (95% CI, 20-32%) of women who had a first vaginal delivery had US-OASI (20 studies; I = 88%). In studies reporting on both clinical and US-OASI rates, 20% (95% CI, 14-28%) of women had AS trauma on ultrasound that was not reported clinically at childbirth (16 studies; I = 90%). No differences were found in maternal age, body mass index, weight, subpubic arch angle, induction of labor, epidural analgesia, episiotomy angle, duration of first/second/active-second stages of labor, vacuum extraction, neonatal birth weight or head circumference between cases with and those without US-OASI. Antenatal perineal massage and use of an intrapartum pelvic floor muscle dilator did not affect the odds of US-OASI. Most (81%) studies were judged to be at high risk of bias in at least one domain and only four (19%) studies had an overall low risk of bias.
CONCLUSION
Given the ultrasound evidence of structural damage to the AS in 26% of women following a first vaginal delivery, clinicians should have a low threshold of suspicion for the condition. This systematic review identified several predictive factors for this. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Anal Canal; Retrospective Studies; Prospective Studies; Delivery, Obstetric; Episiotomy; Anus Diseases; Perineum; Risk Factors; Obstetric Labor Complications
PubMed: 37329513
DOI: 10.1002/uog.26292 -
TouchREVIEWS in Endocrinology May 2023As age increases, adipose tissue infiltrates muscle tissue and leads to sarcopenia. When excessive accumulation of adipose tissue accompanied progressive decrease in... (Review)
Review
As age increases, adipose tissue infiltrates muscle tissue and leads to sarcopenia. When excessive accumulation of adipose tissue accompanied progressive decrease in lean body mass especially visceral fat, termed as sarcopenic obesity (SO) and related metabolic intermuscular adipose tissue (IMAT) is an ectopic tissue found between muscle groups, and is distinct from subcutaneous adipose tissue. Until now, the association between IMAT and metabolic health was not understood. This study is the first systematic review assessing the association between IMAT and metabolic health. The PubMed, Science Direct and Cochrane databases were searched for studies reporting IMAT and metabolic risk. The descriptions of the extracted data are guided by the Preferred Reporting Items for Systematic Reviews (PRISMA) statement with a Grading of Recommendations Assessment, Development and Evaluation approach. This study is registered at PROSPERO (identifier: CRD42022337518). Six studies were pooled and reviewed using critical appraisal by the Newcastle Ottawa Scale and Centre for Evidence-Based Medicine checklist. Two clinical trials and four observational trials were included. Our results reveal that IMAT is associated with metabolic risk, especially in older adults and patients with obesity. However, in a person with abdominal obesity, VAT has a more significant role in metabolic risk than IMAT. The largest decrease in IMAT was achieved by combining aerobic with resistance training.
PubMed: 37313233
DOI: 10.17925/EE.2023.19.1.54 -
Isolated Colonic Histoplasmosis in Patients Undergoing Immunomodulator Therapy: A Systematic Review.Journal of Investigative Medicine High... 2023Gastrointestinal histoplasmosis remains an inconspicuous clinicopathologic entity. It is predominantly considered a protean manifestation of disseminated disease. We... (Review)
Review
Gastrointestinal histoplasmosis remains an inconspicuous clinicopathologic entity. It is predominantly considered a protean manifestation of disseminated disease. We hereby delineate a unique case of biopsy-proven isolated colonic histoplasmosis in a patient undergoing methotrexate therapy. Furthermore, we present the first systematic review of the MEDLINE, Google Scholar, Embase, and Scopus databases regarding isolated colonic histoplasmosis in adult patients receiving immunomodulator therapy (IMT). A total of 13 case reports (level of clinical evidence: IV) were identified. The mean age was 55.6 ± 11.1 years, with 9 (69.2%) cases reported in women. Patients with subclinical disease (5, 38.5%) were often incidentally diagnosed by screening colonoscopy. Symptomatic individuals predominantly presented with diarrhea (4, 30.8%), weight loss (3, 23.1%), and/or abdominal pain (3, 23.1%). IMT was mainly administered for liver transplant (4, 30.8%), renal transplant (4, 30.8%), and ulcerative colitis (2, 15.4%). Common colonoscopy features included colonic ulcerations (7, 53.8%), polyps or pseudopolyps (3, 23.1%), and/or mass-like lesions (3, 23.1%). Diagnosis was made by histology of colonic biopsy in 11 (84.6%) and resected specimens in 2 (15.4%) patients. Treatment consisted of a combination of amphotericin B with oral itraconazole in 6 (46.2%), oral itraconazole alone in 5 (38.5%), and amphotericin B alone in 2 (15.4%) patients. Complete clinical recovery was achieved in all patients. This article illustrates that isolated colonic involvement can be the only clinical presentation of histoplasmosis. It may masquerade as other bowel disorders, presenting diagnostic and therapeutic conundrums. Gastroenterologists should rule out colonic histoplasmosis in IMT recipients who develop unexplained colitis symptoms.
Topics: Adult; Humans; Female; Middle Aged; Aged; Histoplasmosis; Itraconazole; Amphotericin B; Colon; Immunologic Factors
PubMed: 37293945
DOI: 10.1177/23247096231179448 -
Journal of Health, Population, and... Jun 2023Currently, there is no summative study evaluating the association between central obesity and screen time. This systematic review and meta-analysis aimed to summarize... (Meta-Analysis)
Meta-Analysis
Currently, there is no summative study evaluating the association between central obesity and screen time. This systematic review and meta-analysis aimed to summarize the results of studies evaluating the association between screen time and central obesity among children and adolescents. To this end, we performed a systematic search in three electronic databases, including Scopus, PubMed, and Embase to retrieve the related studies up to March 2021. Nine studies were eligible to be included in the meta-analysis. There was no association between odds of central obesity and screen time [odds ratio (OR) 1.136; 95% CI 0.965-1.337; P = 0.125]; however, waist circumference (WC) was 1.23 cm higher in those with highest screen time versus those in the lowest screen time category [weighted mean difference (WMD) = 1.23; 95% 95% CI 0.342-2.112; P = 0.007; Fig. 3]. Moreover, the possible sources of heterogeneity in the included studies were continent and sample size. No evidence of publication bias was reported. For the first time, the current systematic review and meta-analysis revealed that those with the highest screen time had higher WC compared with those with the lowest screen time. Although, there was no association between odds of central obesity and screen time. Due to the observational design of the included studies, it is impossible to infer the cause-effect relationship. Therefore, further interventional and longitudinal studies are warranted to better elucidate the causality of these associations.
Topics: Child; Adolescent; Humans; Obesity, Abdominal; Obesity; Waist Circumference; Body Mass Index
PubMed: 37268998
DOI: 10.1186/s41043-023-00391-5