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World Journal of Gastrointestinal... May 2024Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer (RC), but there were significant differences in the reported...
BACKGROUND
Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer (RC), but there were significant differences in the reported risk factors for complications after stoma reversal. No studies have analyzed the risk factors for stoma-related complications and overall postoperative complications separately.
AIM
To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC.
METHODS
This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022. Continuous variables are expressed as the mean ± SD and were analyzed with independent-sample tests, while frequency variables are expressed as (%), and the test or Fisher's exact test was used. Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications.
RESULTS
The overall complication rate after ileostomy reversal was 11.4%. Patients with lower preoperative albumin concentration ( < 0.01), greater blood loss ( = 0.017), and longer operative times ( < 0.01) were more likely to experience postoperative complications. The incidence of stoma-related complications was 6.4%. Analysis of the study showed that a higher body mass index (BMI) ( < 0.01), preoperative comorbid hypertension ( = 0.049), time from primary surgery to ileostomy reversal ( < 0.01) and longer operation time ( = 0.010) were more likely to result in stoma-related complications postoperatively. Multivariate logistic regression analysis revealed that a lower preoperative albumin level ( < 0.01, OR = 0.888, 95%CI: 0.828-0.958) was an independent risk factor for overall complications. Moreover, multivariate analysis revealed that BMI ( < 0.01, OR = 1.176, 95%CI: 1.041-1.330) and time from primary surgery to ileostomy reversal ( < 0.01, OR = 1.140, 95%CI: 1.038-1.252) were independent risk factors for stoma-related complications after stoma reversal.
CONCLUSION
The preoperative albumin level was a predictor of overall complications. Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.
PubMed: 38817282
DOI: 10.4240/wjgs.v16.i5.1354 -
The Medical Journal of Malaysia May 2024The complete mesocolic excision (CME) and central vascular ligation (CVL) is an advanced surgical technique used to treat colon cancer. It combines the removal of the... (Comparative Study)
Comparative Study
INTRODUCTION
The complete mesocolic excision (CME) and central vascular ligation (CVL) is an advanced surgical technique used to treat colon cancer. It combines the removal of the affected portion of the colon and surrounding lymph nodes with an improved method of controlling the vascular supply to the tumour.
MATERIALS AND METHODS
A retrospective study of patients with colon cancer underwent right hemicolectomy (either CME and CVL or conventional method) were operated by colorectal surgeons in a tertiary centre in Kuala Lumpur from 2018 to 2020. We review the data to compare the oncological, pathological and surgical outcomes of both techniques. Categorical variables were presented as frequencies and percentages. Continuous variables were compared using an independent t-test or Mann-Whitney Rank U test. The chi-square test was used to determine the association between categorical variables and mortality. Statistical analysis was conducted with IBM SPSS Statistics 25.0, and statistical significance was set at p<0.05.
RESULTS
A total of 30 patients (CME and CVL=15 or conventional colectomies=15) were included in this study with mean age of 65 years. There was no statistical difference between the mean age of the two groups (p=0.355). Most of the patients were Malays (46.7%) followed by Chinese (43.3 %) and Indians (10.0%). The mean (SD) = 19 (9) number of lymph nodes harvested is more in CME and CVL groups which however is not statistically significant compared to the mean (SD) = 16 (9), number of lymph nodes in conventional colectomies. The duration of surgery is longer in CME and CVL groups (214 minutes) compared to conventional colectomies (188 minutes) but with no significant statistical difference. Most of the perioperative complications were similar in both groups with no significant statistical differences.
CONCLUSION
CME and CVL are not inferior to conventional surgery in colon surgery in a tertiary centre. It should be considered since the advantages such as lymph node yield and median recurrence free survival are better with similar perioperative morbidity.
Topics: Humans; Colonic Neoplasms; Retrospective Studies; Male; Female; Ligation; Aged; Colectomy; Mesocolon; Middle Aged; Tertiary Care Centers; Malaysia; Treatment Outcome
PubMed: 38817066
DOI: No ID Found -
Palliative Medicine May 2024Digital approaches are being explored internationally to support the elicitation, documentation and sharing of advance care planning information. However, the views and...
BACKGROUND
Digital approaches are being explored internationally to support the elicitation, documentation and sharing of advance care planning information. However, the views and experiences of patients and carers are little understood, impeding the development and impact of digital approaches to strengthen palliative and end-of-life care.
AIM
To explore perspectives of patients with progressive illness and their carers on digital approaches to advance care planning, anticipated impact from their use and expectations for their future development.
DESIGN
A qualitative study employing thematic framework analysis of data collected from focus groups and semi-structured interviews.
SETTING/PARTICIPANTS
Purposive sample of 29 patients and 15 current or bereaved carers in London and West Yorkshire from hospice settings, non-governmental support and advocacy groups, and care home residents.
RESULTS
Four generated themes included: 1. ''; uncertainty around professionals' documenting, sharing and use of information; 2. The art of decision-making relies on the art of conversation; 3. The perceived value in having '': control and responsibility; 4. Enabling patient and carer control of their records: ''.
CONCLUSIONS
Lived experiences of information sharing influenced trust and confidence in digital advance care planning systems. Despite scepticism about the extent that care can be delivered in line with their preferences, patients and carers acknowledge digital systems could facilitate care through contemporaneous and accurately documented wishes and preferences. There remains a need to determine how independent patient and public-facing advance care planning resources might be integrated with existing digital health record systems.
PubMed: 38813756
DOI: 10.1177/02692163241255511 -
Turkish Journal of Medical Sciences 2023The aim of this study was to develop a gestational diabetes risk assessment scale (GEDRISK).
BACKGROUND/AIM
The aim of this study was to develop a gestational diabetes risk assessment scale (GEDRISK).
MATERIALS AND METHODS
This methodological study included 652 pregnant women who presented to six public health institutions in İstanbul between September 2021 and February 2022. Content validity was evaluated using the content validity index, while construct validity was assessed through exploratory and confirmatory factor analyses. Item discrimination was examined using Cronbach's alpha coefficients, Spearman-Brown and Guttman coefficients, item-total correlation tests, and 27% lower and upper quartile t tests. Reliability was determined through test-retest analysis methods.
RESULTS
The scale-level content validity index demonstrated strong coherence at 0.83, confirming its robustness. In the EFA, the scale, comprising 18 items and 5 subdimensions, accounted for 57.48% of the variance (n = 652). The results of the confirmatory factor analysis were as follows: χ/df = 2.28; RMR = 0.01; CFI, GFI, and IFI = 0.95; AGFI = 0.93; NFI = 0.92; RFI = 0.90; and RMSEA = 0.04. The Spearman-Brown and Guttman split-half coefficient equal length analysis produced a result of 0.826, Cronbach's alpha value was 0.756, and the temporal consistency of the scale was evaluated with the test-retest method (p = 0.184). The structure of the scale was evaluated with a validity and reliability analysis and was found to have acceptable, valid, and reliable properties. The mean total GEDRISK score of the pregnant women participating in the study was 33.57 ± 4.71. It was observed that the GEDRISK scale identified 51% of the respondents diagnosed with diabetes through an oral glucose tolerance test.
CONCLUSION
The GEDRISK scale was found to be a valid and reliable tool for the measurement of gestational diabetes risk in a sample of the Turkish population.
Topics: Humans; Diabetes, Gestational; Female; Pregnancy; Risk Assessment; Reproducibility of Results; Adult; Surveys and Questionnaires; Turkey; Psychometrics; Young Adult; Factor Analysis, Statistical
PubMed: 38813485
DOI: 10.55730/1300-0144.5755 -
Frontiers in Public Health 2024Light's non-visual effects on the biological clock, cognitive performance, alertness, and mental health are getting more recognized. These are primarily driven by blue...
INTRODUCTION
Light's non-visual effects on the biological clock, cognitive performance, alertness, and mental health are getting more recognized. These are primarily driven by blue light, which triggers specific retinal cells containing melanopsin. Traditionally, research on light has relied on correlated color temperature (CCT) as a metric of its biological influence, given that bluer light corresponds to higher Kelvin values. However, CCT proves to be an inadequate proxy of light's biological effects. A more precise metric is melanopic Equivalent Daylight Illuminance (mel-EDI), which aligns with melanopsin spectrum. Studies have reported positive cognitive impacts of blue-enriched white light. It's unclear if the mixed results are due to different mel-EDI levels since this factor wasn't assessed.
METHOD
Given recent recommendations from experts to aim for at least 250 mel-EDI exposure daily for cognitive benefits, our aim was to assess if a 50-minute exposure to LED light with 250 mel-EDI could enhance concentration and alertness, without affecting visual performance or comfort compared to conventional lighting producing around 150 mel-EDI. To ensure mel-EDI's impact, photopic lux levels were kept constant across conditions. Conditions were counterbalanced, parameters included subjective sleepiness (KSS; Karolinska Sleepiness Scale), concentration (d2-R test), visual performance (FrACT; Freiburg Visual Acuity and Contrast Test), general appreciation (VAS; Visual Analogous Scale), preferences and comfort (modified OLS; Office Lighting Survey).
RESULTS
The experimental light significantly reduced sleepiness ( = 0.03, Cohen's d = 0.42) and also decreased contrast sensitivity ( = 0.01, Cohen's d = 0.50). The conventional light was found to be more comfortable ( = 0.002, Cohen's d = 0.62), cheerful ( = 0.02, Cohen's d = 0.46) and pleasant ( = 0.005, Cohen's d = 0.55) while the experimental light was perceived as brighter ( = 0.004, Cohen's d = 0.58) and tended to be more stimulating ( = 0.10). Notably, there was a preference for conventional lighting ( = 0.004, Cohen's d=0.56) and concentration was equally improved in both conditions.
DISCUSSION
Despite the lack of further improvement in concentration from exposure to blue-enriched light, given the observed benefits in terms of vigilance, further research over an extended period would be justified. These findings could subsequently motivate cognitive optimization through lighting for workers that would benefit from artificial lighting such as in northern regions.
Topics: Humans; Lighting; Cognition; Male; Arousal; Female; Light; Adult; Young Adult; Color; White
PubMed: 38813427
DOI: 10.3389/fpubh.2024.1390614 -
World Journal of Gastroenterology May 2024Chronic viral hepatitis causes an increased risk of progressive liver disease and hepatocellular carcinoma. On the wave of the World Health Organization's goal to reduce...
Chronic viral hepatitis causes an increased risk of progressive liver disease and hepatocellular carcinoma. On the wave of the World Health Organization's goal to reduce new cases and deaths from hepatitis B and C by 2030, there is an increasing call to expand the indications for treatment of chronic hepatitis B. Currently, the main goal of treatment is to achieve a functional cure due to the inability of current drugs to completely eradicate the virus. There are still many discrepancies between available guidelines in terms of eligibility for treatment as well as an uncertainty about the appropriate treatment duration. This editorial addresses key questions about the topic and whether indications for treatment should be expanded.
Topics: Humans; Hepatitis B, Chronic; Antiviral Agents; Hepatitis B virus; Liver Neoplasms; Practice Guidelines as Topic; Carcinoma, Hepatocellular; Treatment Outcome; Patient Selection
PubMed: 38813053
DOI: 10.3748/wjg.v30.i17.2294 -
Turkish Journal of Medical Sciences 2023Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting mostly small joints, such as hand and foot joints symmetrically with irreversible joint...
BACKGROUND/AIM
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting mostly small joints, such as hand and foot joints symmetrically with irreversible joint destruction. In this study, the relationship between CD39 expression and the treatment response of RA patients was examined to investigate its potential as a biomarker that demonstrates treatment response.
MATERIALS AND METHODS
This study included 77 RA patients and 40 healthy controls (HC). The RA patients were divided into 2 groups based on their response to RA treatment, those with a good response to methotrexate (MTX) monotherapy and those with an inadequate response based on the American College of Rheumatology and the European League Against Rheumatism response criteria. Various immunological parameters and Disease Activity Score in 28 Joints (DAS28) were examined between the groups using the Student's t-test.
RESULTS
The monocytic myeloid-derived suppressor cell (M-MDSC) percentage was higher in the RA patient group versus the HC group. The CD39 expression in the T lymphocytes were higher in patients that responded well to the MTX compared to those showing inadequate response. Additionally, s negative correlation was found between the DAS28 and CD39 in the T cells.
CONCLUSION
The results showed that the improvement in treatment response to the therapy in RA patients could be because of the enhancement in the CD39/adenosine (ADO) pathway. Therefore, therapies targeting the CD39/ADO pathway in T cells may improve RA treatments.
Topics: Humans; Arthritis, Rheumatoid; Methotrexate; Female; Male; Apyrase; Middle Aged; Antirheumatic Agents; Adult; Biomarkers; Treatment Outcome; Antigens, CD; Case-Control Studies; Aged; T-Lymphocytes
PubMed: 38813034
DOI: 10.55730/1300-0144.5672 -
Turkish Journal of Medical Sciences 2023The clinical presentation of pediatric coronavirus disease 2019 (COVID-19) is associated with a milder disease course than the adult COVID-19 syndrome. The disease...
BACKGROUND/AIM
The clinical presentation of pediatric coronavirus disease 2019 (COVID-19) is associated with a milder disease course than the adult COVID-19 syndrome. The disease course of COVID-19 has three clinicobiological phases: initiation, propagation, and complication. This study aimed to assess the pathobiological alterations affecting the distinct clinical courses of COVID-19 in pediatric age groups versus the adult population. We hypothesized that critical biogenomic marker expressions drive the mild clinical presentations of pediatric COVID-19.
MATERIALS AND METHODS
Blood samples were obtained from 72 patients with COVID-19 hospitalized at Ankara City Hospital between March and July 2021. Peripheral blood mononuclear cells were isolated using Ficoll-Paque and density-gradient sedimentation. The groups were compared using a t-test and limma analyses. Mean standardized gene expression levels were used to hierarchically cluster genes employing Euclidean Gene Cluster 3.0. The expression levels of identified genes were determined using reverse transcription-polymerase chain reaction.
RESULTS
This study found that gene expression was significantly downregulated in the pediatric group (p < 0.05, FC: 1.57) and gene expression was significantly upregulated in the adult group (p < 0.05, FC: 2.98). The study results indicated that the expression of critical biogenomic markers, such as the first-phase ( and ) and second-phase ( and ) receptor genes, was crucial in the genesis of mild clinical presentations of pediatric COVID-19. gene expression was lower in pediatric COVID-19.
CONCLUSION
The interrelationship between the and genes may prevent the progression of COVID-19 from initiation to the propagating phase in pediatric patients. High gene expression could potentially contribute to a protective effect and may be a contributing factor for the mild clinical course observed in pediatric patients.
Topics: Humans; COVID-19; Child; Male; Female; Adult; SARS-CoV-2; Child, Preschool; Adolescent; Middle Aged; Age Factors
PubMed: 38813031
DOI: 10.55730/1300-0144.5685 -
Digital Health 2024The aim of this study was to investigate the online presence of French dental practices that have a professional website. Secondly, the degree of compliance of...
OBJECTIVE
The aim of this study was to investigate the online presence of French dental practices that have a professional website. Secondly, the degree of compliance of practices' websites with the current regulatory framework was assessed.
METHODS
Open data was used to identify a 5% random sample of private dental practices in France ( = 1370 facilities). Then, a manual search was made on Google to find the website for each practice. When found, the website was analyzed using criteria.
RESULTS
Only 25.9% of dental practices have a functional and referenced website, allowing 28.9% of the dentists in the sample to have an online presence. Disparities exist depending on the geographical location of the facility and its type. The assessment of website content uncovered a lack of compliance with the existing regulatory framework, exhibiting variations based on the type of facility and the person who designed the website. Hiring a specialized web design provider for dentists enhances compliance with laws and guidelines, though it doesn't guarantee complete adherence.
CONCLUSIONS
The online presence of dental practices and dentists in France is limited. Where they do exist, dental practice websites generally do not comply with legal requirements and guidelines for online communication. Efforts should be made to improve the information provided to patients.
PubMed: 38812847
DOI: 10.1177/20552076241258143 -
Diabetes, Metabolic Syndrome and... 2024The clinical background and prognostic impact of diabetes mellitus (DM) on vasospastic angina (VSA) are unclear; thus, in this retrospective study, we investigated...
PURPOSE
The clinical background and prognostic impact of diabetes mellitus (DM) on vasospastic angina (VSA) are unclear; thus, in this retrospective study, we investigated whether they differ based on the presence or absence of DM in patients with VSA.
PATIENTS AND METHODS
We included 272 Japanese patients with VSA diagnosed by coronary angiography (CAG) and the spasm provocation test (SPT). The diagnosis of DM was determined by measuring fasting blood glucose and hemoglobin A1C and by the patient's current oral medications. On CAG, the presence of atherosclerotic lesions (20%-50%) was checked. On SPT, the coronary spasm was defined as transient coronary vasoconstriction >90% on CAG, accompanied by chest symptoms and/or ST-T changes. Focal spasm was defined as coronary spasm occurring within one segment of the American Heart Association classification on CAG. Blood and urine tests and vascular endothelial function were also evaluated when possible. A major adverse cardiovascular event (MACE), which is defined as cardiac mortality and rehospitalization due to cardiovascular illness, was the basis for determining the prognosis.
RESULTS
There were 49 patients (18%) in the DM group and 223 (82%) in the non-DM group. No significant differences in urinary albumin levels and peripheral vascular function were between groups. On CAG, atherosclerotic lesions were observed significantly more frequently in the DM group (63% vs 46%; P = 0.028). Results of SPT showed a trend toward fewer focal spasms in the DM group (24% vs 39%; P = 0.072). No significant differences in MACE were noted between groups in the primary analysis of DM, whereas sub-analyses of focal spasms showed lower MACE-free survival in the DM group (P = 0.042).
CONCLUSION
The study results support the hypothesis that DM associated with VSA should be treated appropriately, especially in cases of focal spasm, which may require more attention in treatment.
PubMed: 38812745
DOI: 10.2147/DMSO.S462234