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Asian Journal of Surgery Jun 2024
PubMed: 38879362
DOI: 10.1016/j.asjsur.2024.05.247 -
The Journal of Infection Jun 2024Implant-based reconstructions are increasingly utilized following mastectomy in the prevention and treatment of breast cancer. However, these implants are associated... (Review)
Review
Implant-based reconstructions are increasingly utilized following mastectomy in the prevention and treatment of breast cancer. However, these implants are associated with a high rate of infection, which is a major complication that can lead to implant removal, delay in adjuvant radiation and chemotherapy, and increase in health care costs. Early clinical signs and symptoms of infection, such as erythema, warmth, and tenderness, are challenging to discern from expected postsurgical responses. Furthermore, when atypical features are present or the patient's condition does not improve on adequate antimicrobials, the clinician should be prompted to consider an alternative noninfectious etiology. Herein we highlight the key elements of the preventive, diagnostic, and multidisciplinary therapeutic approach to salvaging the infected breast implant; review several infectious disease mimickers; and provide many pearls of wisdom that the practicing clinician must be familiar with and be able to manage in an effective and successful manner. SUMMARY: Breast implant-based reconstructive procedures after mastectomy has been historically associated with an elevated infection rate. Herein, we perform a comprehensive review on many key aspects on the prevention, diagnosis, treatment, and mimickers of these complex implant-related infections.
PubMed: 38879134
DOI: 10.1016/j.jinf.2024.106197 -
Pharmacological Research Jun 2024Cerebral ischemia-reperfusion injury (I/RI) is one of the principal pathogenic factors in the poor prognosis of ischemic stroke, for which current therapeutic options to...
Transfer of miR-877-3p via extracellular vesicles derived from dental pulp stem cells attenuates neuronal apoptosis and facilitates early neurological functional recovery after cerebral ischemia-reperfusion injury through the Bclaf1/p53 signaling pathway.
Cerebral ischemia-reperfusion injury (I/RI) is one of the principal pathogenic factors in the poor prognosis of ischemic stroke, for which current therapeutic options to enhance neurological recovery are notably insufficient. Dental pulp stem cell-derived extracellular vesicles (DPSC-EVs) have promising prospects in stroke treatment and the specific underlying mechanisms have yet to be fully elucidated. The present study observed that DPSC-EVs ameliorated the degree of cerebral edema and infarct volume by reducing the apoptosis of neurons. Furthermore, the miRNA sequencing and functional enrichment analysis identified that miR-877-3p as a key component in DPSC-EVs, contributing to neuroprotection and anti-apoptotic effects. Following target prediction and dual-luciferase assay indicated that miR-877-3p interacted with Bcl-2-associated transcription factor (Bclaf1) to play a function. The miR-877-3p inhibitor or Bclaf1 overexpression reversed the neuroprotective effects of DPSC-EVs. The findings reveal a novel therapeutic pathway where miR-877-3p, transferred via DPSC-EVs, confers neuroprotection against cerebral I/RI, highlighting its potential in promoting neuronal survival and recovery post-ischemia.
PubMed: 38878918
DOI: 10.1016/j.phrs.2024.107266 -
Journal of Experimental & Clinical... Jun 2024Breast cancer (BC) is a complex disease, showing heterogeneity in the genetic background, molecular subtype, and treatment algorithm. Historically, treatment strategies...
BACKGROUND
Breast cancer (BC) is a complex disease, showing heterogeneity in the genetic background, molecular subtype, and treatment algorithm. Historically, treatment strategies have been directed towards cancer cells, but these are not the unique components of the tumor bulk, where a key role is played by the tumor microenvironment (TME), whose better understanding could be crucial to obtain better outcomes.
METHODS
We evaluated mitochondrial transfer (MT) by co-culturing Adipose stem cells with different Breast cancer cells (BCCs), through MitoTracker assay, Mitoception, confocal and immunofluorescence analyses. MT inhibitors were used to confirm the MT by Tunneling Nano Tubes (TNTs). MT effect on multi-drug resistance (MDR) was assessed using Doxorubicin assay and ABC transporter evaluation. In addition, ATP production was measured by Oxygen Consumption rates (OCR) and Immunoblot analysis.
RESULTS
We found that MT occurs via Tunneling Nano Tubes (TNTs) and can be blocked by actin polymerization inhibitors. Furthermore, in hybrid co-cultures between ASCs and patient-derived organoids we found a massive MT. Breast Cancer cells (BCCs) with ASCs derived mitochondria (ADM) showed a reduced HIF-1α expression in hypoxic conditions, with an increased ATP production driving ABC transporters-mediated multi-drug resistance (MDR), linked to oxidative phosphorylation metabolism rewiring.
CONCLUSIONS
We provide a proof-of-concept of the occurrence of Mitochondrial Transfer (MT) from Adipose Stem Cells (ASCs) to BC models. Blocking MT from ASCs to BCCs could be a new effective therapeutic strategy for BC treatment.
Topics: Humans; Breast Neoplasms; Female; Mitochondria; Drug Resistance, Neoplasm; Drug Resistance, Multiple; Stem Cells; Adipose Tissue; Cell Line, Tumor; Tumor Microenvironment
PubMed: 38877575
DOI: 10.1186/s13046-024-03087-8 -
World Journal of Surgical Oncology Jun 2024This study aims to investigate the clinical and pathological characteristics, treatment approaches, and prognosis of gallbladder neuroendocrine carcinoma (GB-NEC).
OBJECTIVE
This study aims to investigate the clinical and pathological characteristics, treatment approaches, and prognosis of gallbladder neuroendocrine carcinoma (GB-NEC).
METHODS
Retrospective analysis was conducted on the clinical data of 37 patients with GB-NEC admitted to Shanxi Cancer Hospital from January 2010 to June 2023. The study included an examination of their general information, treatment regimens, and overall prognosis.
RESULTS
Twelve cases, either due to distant metastasis or other reasons, did not undergo surgical treatment and received palliative chemotherapy (Group 1). Two cases underwent simple cholecystectomy (Group 2); four patients underwent palliative tumor resection surgery (Group 3), and nineteen patients underwent radical resection surgery (Group 4). Among the 37 GB-NEC patients, the average pre-surgery CA19-9 level was 113.29 ± 138.45 U/mL, and the median overall survival time was 19 months (range 7.89-30.11 months). Of these, 28 cases (75.7%) received systemic treatment, 25 cases (67.6%) underwent surgical intervention, and 16 cases (64.0%) received postoperative adjuvant treatment, including combined radiochemotherapy or chemotherapy alone. The median overall survival time was 4 months (0.61-7.40 months) for Group 1 (n = 12), 8 months for Group 2 (n = 2), 21 months (14.67-43.33 months) for Group 3 (n = 4), and 19 months (range 7.89-30.11 months) for Group 4 (n = 19). A significant difference in median overall survival time was observed between Group 1 and Group 4 (P = 0.004).
CONCLUSION
Surgery remains the primary treatment for GB-NEC, with radical resection potentially offering greater benefits to patient survival compared to other therapeutic options. Postoperative adjuvant therapy has the potential to extend patient survival, although the overall prognosis remains challenging.
Topics: Humans; Gallbladder Neoplasms; Male; Female; Carcinoma, Neuroendocrine; Middle Aged; Retrospective Studies; Aged; Prognosis; Survival Rate; Adult; Cholecystectomy; Follow-Up Studies; Combined Modality Therapy
PubMed: 38877554
DOI: 10.1186/s12957-024-03436-z -
BMC Surgery Jun 2024Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially...
Early safety and efficiency outcomes of a novel interdisciplinary laparoscopic resection rectopexy combined with sacrocolpopexy for women with obstructive defecation syndrome and pelvic organ prolapse: a single center study.
BACKGROUND
Obstructive defecation syndrome (ODS) defines a disturbed defecation process frequently associated with pelvic organ prolapse (POP) in women that substantially compromises quality of life. Conservative management offers limited relief and a surgical intervention may be required. This is characterized by individual approaches. AIM OF THE STUDY: This retrospective single center study evaluated the surgical and clinical short-term outcome of a novel interdisciplinary laparoscopic resection rectopexy (L-RRP) with mesh- sacrocolpopexy (L-SCP) for women suffering from ODS and POP.
METHODS
The study participants underwent surgery in an interdisciplinary laparoscopic approach. Safety was the primary endpoint, assessed via postoperative morbidity classified by Clavien-Dindo scale. Secondary outcomes included evaluation of bowel function, fecal and urinary incontinence and pelvic organ prolapse status at 12 months follow-up. Additionally, a biological mesh (BM) was offered to women, who asked for an alternative to synthetic mesh material (SM).
RESULTS
Of the 44 consecutive patients requiring surgery for ODS and POP, 36 patients underwent the interdisciplinary surgical approach; 28 patients with SM and 8 patients with BM. In total 5 complications occurred, four of them were classified as minor. One minor complication was observed in the BM group. One anastomotic leakage occurred in the SM group. The two ODS scores, the bowel dysfunction score, and the incontinence score improved significantly (p = 0.006, p = 0.003, p < 0.001, and p = 0.0035, respectively). Pelvic floor anatomy was fully restored (POP-Q 0) for 29 (80%) patients after surgery. 17 patients (47%) suffered from urinary incontinence before surgery, which was restored in 13 patients (76.5%).
CONCLUSIONS
The interdisciplinary approach with L-RRP and L-SCP and the use of a BM in a small subgroup were technically feasible, safe, and effective in this single center setting. The study's retrospective design, the small sample size and the lack of comparators limit the generalizability of the findings requiring future randomized trials.
TRIAL REGISTRATION
Retrospectively registered at clinicaltrials.gov, trial number NCT05910021, date of registration 06/10/2023.
Topics: Humans; Female; Retrospective Studies; Pelvic Organ Prolapse; Laparoscopy; Middle Aged; Aged; Surgical Mesh; Treatment Outcome; Vagina; Rectum; Defecation; Postoperative Complications; Gynecologic Surgical Procedures; Syndrome; Constipation
PubMed: 38877450
DOI: 10.1186/s12893-024-02474-4 -
Scientific Reports Jun 2024Determining the fundamental characteristics that define a face as "feminine" or "masculine" has long fascinated anatomists and plastic surgeons, particularly those...
Determining the fundamental characteristics that define a face as "feminine" or "masculine" has long fascinated anatomists and plastic surgeons, particularly those involved in aesthetic and gender-affirming surgery. Previous studies in this area have relied on manual measurements, comparative anatomy, and heuristic landmark-based feature extraction. In this study, we collected retrospectively at Cedars Sinai Medical Center (CSMC) a dataset of 98 skull samples, which is the first dataset of this kind of 3D medical imaging. We then evaluated the accuracy of multiple deep learning neural network architectures on sex classification with this dataset. Specifically, we evaluated methods representing three different 3D data modeling approaches: Resnet3D, PointNet++, and MeshNet. Despite the limited number of imaging samples, our testing results show that all three approaches achieve AUC scores above 0.9 after convergence. PointNet++ exhibits the highest accuracy, while MeshNet has the lowest. Our findings suggest that accuracy is not solely dependent on the sparsity of data representation but also on the architecture design, with MeshNet's lower accuracy likely due to the lack of a hierarchical structure for progressive data abstraction. Furthermore, we studied a problem related to sex determination, which is the analysis of the various morphological features that affect sex classification. We proposed and developed a new method based on morphological gradients to visualize features that influence model decision making. The method based on morphological gradients is an alternative to the standard saliency map, and the new method provides better visualization of feature importance. Our study is the first to develop and evaluate deep learning models for analyzing 3D facial skull images to identify imaging feature differences between individuals assigned male or female at birth. These findings may be useful for planning and evaluating craniofacial surgery, particularly gender-affirming procedures, such as facial feminization surgery.
Topics: Humans; Skull; Imaging, Three-Dimensional; Female; Male; Neural Networks, Computer; Deep Learning; Retrospective Studies; Sex Characteristics; Adult; Image Processing, Computer-Assisted
PubMed: 38877045
DOI: 10.1038/s41598-024-61879-6 -
Journal of Plastic, Reconstructive &... May 2024Total or subtotal glossectomy defects cause significant functional deficits in swallowing and speech and subsequently impair patients' quality of life (QOL). Recently,...
BACKGROUND
Total or subtotal glossectomy defects cause significant functional deficits in swallowing and speech and subsequently impair patients' quality of life (QOL). Recently, the profunda artery perforator (PAP) flap has emerged as a potential alternative for reconstructing extensive glossectomy defects. While previous studies assessing recovery of neurotized anterolateral thigh (ALT) flaps in head and neck reconstruction reported superior sensory recovery, improved swallow function, and improved overall patient satisfaction in patients with neurotized flaps vs. non-neurotized ALT flap reconstruction, PAP flap neurotization has not been described and systematically assessed in head and neck patients.
METHODS
Six patients underwent subtotal tongue reconstruction with neurotized PAP flaps at the authors' institution from May 2022 until August 2023. A branch of the posterior femoral cutaneous nerve of the PAP flap was coaptated to the lingual nerve. Two-point discrimination, Semmes-Weinstein monofilament, pain, and temperature assessments were conducted at 3, 6, and 12 months postoperatively on the neo-tongue. The MD Anderson speech and deglutition scales and the EORTC-QLQ-H&N35 were used to record functional outcomes and QOL.
RESULTS
The mean age was 69 ± 4 years, and the mean body mass index was 25 ± 7 kg/m. Neo-tongue median 2-point discrimination at the tip improved from >10 mm at 3 months to 6 mm at 12 months. All patients had protective pain and temperature perception at the neo-tongue tip at the 6-month follow-up. Speech and swallowing functions were similar at the 12-month follow-up to data on neurotized ALT flaps from literature. No neuropathic pain was reported at the donor site at the 6-month follow-up.
CONCLUSIONS
This is the first case series of PAP flap neurotization in head and neck patients, suggesting potential functional advantages with minimal donor-site morbidity.
LEVEL OF EVIDENCE
V Case Series.
PubMed: 38875869
DOI: 10.1016/j.bjps.2024.05.028 -
JMIR AI Jan 2024ChatGPT (Open AI) is a state-of-the-art large language model that uses artificial intelligence (AI) to address questions across diverse topics. The American Society of...
BACKGROUND
ChatGPT (Open AI) is a state-of-the-art large language model that uses artificial intelligence (AI) to address questions across diverse topics. The American Society of Clinical Oncology Self-Evaluation Program (ASCO-SEP) created a comprehensive educational program to help physicians keep up to date with the many rapid advances in the field. The question bank consists of multiple choice questions addressing the many facets of cancer care, including diagnosis, treatment, and supportive care. As ChatGPT applications rapidly expand, it becomes vital to ascertain if the knowledge of ChatGPT-3.5 matches the established standards that oncologists are recommended to follow.
OBJECTIVE
This study aims to evaluate whether ChatGPT-3.5's knowledge aligns with the established benchmarks that oncologists are expected to adhere to. This will furnish us with a deeper understanding of the potential applications of this tool as a support for clinical decision-making.
METHODS
We conducted a systematic assessment of the performance of ChatGPT-3.5 on the ASCO-SEP, the leading educational and assessment tool for medical oncologists in training and practice. Over 1000 multiple choice questions covering the spectrum of cancer care were extracted. Questions were categorized by cancer type or discipline, with subcategorization as treatment, diagnosis, or other. Answers were scored as correct if ChatGPT-3.5 selected the answer as defined by ASCO-SEP.
RESULTS
Overall, ChatGPT-3.5 achieved a score of 56.1% (583/1040) for the correct answers provided. The program demonstrated varying levels of accuracy across cancer types or disciplines. The highest accuracy was observed in questions related to developmental therapeutics (8/10; 80% correct), while the lowest accuracy was observed in questions related to gastrointestinal cancer (102/209; 48.8% correct). There was no significant difference in the program's performance across the predefined subcategories of diagnosis, treatment, and other (P=.16, which is greater than .05).
CONCLUSIONS
This study evaluated ChatGPT-3.5's oncology knowledge using the ASCO-SEP, aiming to address uncertainties regarding AI tools like ChatGPT in clinical decision-making. Our findings suggest that while ChatGPT-3.5 offers a hopeful outlook for AI in oncology, its present performance in ASCO-SEP tests necessitates further refinement to reach the requisite competency levels. Future assessments could explore ChatGPT's clinical decision support capabilities with real-world clinical scenarios, its ease of integration into medical workflows, and its potential to foster interdisciplinary collaboration and patient engagement in health care settings.
PubMed: 38875575
DOI: 10.2196/50442 -
Medicine Jun 2024Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore,... (Observational Study)
Observational Study
Reproducibility of pop sensation, Thompson sign in achillotomy, and final Pirani score to predict clubfoot relapse: Achillotomy clinical signs and Pirani predictive ability.
Ultrasound (US) can guide and confirm percutaneous release of the achilles tendon in the clubfoot. However, this technique may not always be available; therefore, surgeons' reported feelings of tendon release ("click" or "pop") and the Thompson sign could demonstrate that they are sensitive and reliable for confirming complete tendon release. The purpose of this study was to compare the reproducibility of clinical maneuvers that aim to detect the reported "click" or "pop" sensation by the surgeon and the Thompson sign after surgical release in percutaneous achilles tenotomy compare with US in patients with clubfoot. A cross-sectional reproducibility study of consecutive patients with idiopathic clubfoot was conducted. All the patients were scheduled to undergo tenotomy in the operating room using the standard percutaneous achilles tenotomy technique under sedation. The surgeon's reported surgical sensation ("click" or "pop") and Thompson signs were compared to the US assessment of the cut. The final Pirani score was used to predict recurrence risk and was correlated with the number of plaster casts and age. Forty-five feet were affected in 30 patients. Eighteen (60%) men. Age range: 1 to 60 months. The sensation of "click" or "pop" was recorded in 38 patients, and complete release was confirmed by US in 37 patients, for a sensitivity (Se) of 0.95 and specificity (Sp) of 0.63. Thompson signs were positive in 33 and 36 patients at 2 evaluations, with Se values of 0.87 and 0.92 and Sp values of 0.88 and 0.75, respectively. The Pirani final score, a predictor of recurrence risk, had an area under the curve of 0.80 (95% CI = 0.63-0.97; P = .005), Se = 0.78, and Sp = 0.56, with a cutoff point of 2.75. The feeling of achilles tendon release and Thompson sign had high sensitivity, prevalence, accuracy, and posttest probability. The confirmation of tendon release based on clinical signs could prevent the use of US.
Topics: Humans; Clubfoot; Male; Female; Recurrence; Achilles Tendon; Cross-Sectional Studies; Infant; Tenotomy; Reproducibility of Results; Child, Preschool; Ultrasonography; Predictive Value of Tests
PubMed: 38875390
DOI: 10.1097/MD.0000000000038377