Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria ...Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cy展开更多
Background and Aims:Rifaximin is effective in prevent-ing and treating hepatic encephalopathy(HE).This study aimed to investigate the efficacy and safety of different dosages of rifaximin in the treatment of cirrhotic...Background and Aims:Rifaximin is effective in prevent-ing and treating hepatic encephalopathy(HE).This study aimed to investigate the efficacy and safety of different dosages of rifaximin in the treatment of cirrhotic patients with covert HE(CHE).Methods:In this single-center,ran-domized,controlled,open-label study,CHE was diagnosed using a combination of the psychometric HE score and the EncephalApp Stroop test.Cirrhotic patients with CHE were recruited and randomly assigned to low-dose rifaximin 800 mg/day,high-dose rifaximin(1,200 mg/day),and control groups,and were treated for 8 weeks.The sickness impact profile(SIP)scale was used to evaluate the health-relat-ed quality of life(HRQOL)of patients.Forty patients were included in the study,12 were assigned to the low-dose group,14 to the high-dose group,and 14 patients to the control group.Results:The percentage of patients with CHE reversal was significantly higher in both the low-dose(41.67%,5/12)and high-dose(57.14%,8/14)groups than in the control group(7.14%,1/14)at 8 weeks(p=0.037 and p=0.005,respectively).In addition,both doses of ri-faximin resulted in significant improvement of the total SIP score compared with the control group.There were no sig-nificant differences in the CHE reversal rate,total SIP score improvement,and incidence of adverse event between the low-dose and high-dose groups(p>0.05).Conclusions:Low-dose rifaximin reverses CHE and improves HRQOL in cirrhotic patients with comparable effects and safety to high-dose rifaximin.展开更多
This single-center, randomized, and controlled intervention study compared an acrylate skin adhesive, EpinexusTM (Mitsui Chemicals, Inc., Tokyo) with Dermabond AdvancedR (Ethicon, Inc., Somerville, New Jersey). The pr...This single-center, randomized, and controlled intervention study compared an acrylate skin adhesive, EpinexusTM (Mitsui Chemicals, Inc., Tokyo) with Dermabond AdvancedR (Ethicon, Inc., Somerville, New Jersey). The primary endpoint was cosmetic outcome at 52 weeks after treatment (Manchester Scar Scale), and the secondary endpoints were cosmetic outcome at 4 and 26 weeks after treatment (Manchester Scar Scale), wound closure, and usability. We evaluated 59 patients (29 cases and 30 controls). Failures and adverse events were also evaluated, and 8 adverse events (5 cases and 3 controls) were reported (epidermolysis, n = 4;contact dermatitis, n = 1;eczema, n = 1;and surgical wound dehiscence, n = 2). No difference was observed between groups in cosmetic outcome at 52 and 24 weeks;however, at 4 weeks, cases showed better cosmetic outcome compared with controls. With regard to usability, the treatment duration and application time were significantly longer with EpinexusTM, and ease of application was significantly better with Dermabond AdvancedR.展开更多
BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single c...BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single center.METHODS Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified.Surgical details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were evaluated.The learning curve for LLR was evaluated using the cumulative sum method.The Kaplan-Meier method was used to perform survival analysis.RESULTS Ultimately,1098 patients were identified.Hepatocellular carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 min.The conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,respectively.The learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.展开更多
AIM:To investigate perioperative patient morbidity/mortality and outcome after cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS:Of 150 patients 100 were treated with cytoreductiv...AIM:To investigate perioperative patient morbidity/mortality and outcome after cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS:Of 150 patients 100 were treated with cytoreductive surgery and HIPEC and retrospectively analyzed.Clinical and postoperative follow-up data were evaluated.Body mass index(BMI),age and peritoneal carcinomatosis index(PCI) were chosen as selection criteria with regard to tumor-free survival and perioperative morbidity for this multimodal therapy.RESULTS:CRS with HIPEC was successfully performed in 100 out of 150 patients.Fifty patients were excluded because of intraoperative contraindication.Median PCI was 17(1-39).In 89% a radical resection(CC0/CC1) was achieved.One patient died postoperatively due to multiorgan failure.Neither PCI,age nor BMI was a risk factor for postoperative complications/outcome according to the DINDO classification.In 9% Re-CRS with HIPEC was performed during the follow-up period.CONCLUSION:Patient selection remains the most important issue.Neither PCI,age nor BMI alone should be an exclusion criterion for this multimodal therapy.展开更多
文摘Background: Acute Kidney Injury (AKI) stands as a prominent postoperative complication in on-pump cardiac surgery, with repercussions on morbidity, mortality, and hospitalization duration. Current diagnostic criteria relying on serum creatinine levels exhibit a delayed identification of AKI, prompting an exploration of alternative biomarkers. Aims and Objectives: This study is designed to overcome diagnostic constraints and explore the viability of serum Cystatin C as an early predictor of Acute Kidney Injury (AKI) in individuals undergoing on-pump cardiac surgery. The investigation aims to establish the relationship between serum Cystatin C levels and the onset of AKI in patients subjected to on-pump cardiac surgery. Primary objectives involve the assessment of the diagnostic effectiveness of serum Cystatin C, its comparison with serum creatinine, and the exploration of its potential for the early identification and treatment of AKI. Methodology: Conducted as a single-center study at the cardiac surgery department of BSMMU in Bangladesh from September 2020 to August 2022, a comparative cross-sectional analysis involved 31 participants categorized into No AKI and AKI groups based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Data collection encompassed preoperative, post-CBP (cardiopulmonary bypass) conclusion at 2 hours, postoperative day 1, and postoperative day 2 intervals. Statistical analyses included Chi-squared tests, independent Student’s t-tests, and one-sample t-tests. Significance was set at P Results: The study revealed no significant differences in baseline characteristics between the No AKI and AKI groups, except for CPB time and cross-clamp time. Serum Cystatin C levels in the AKI group exhibited statistical significance at various time points, highlighting its potential as an early detector. Conversely, Serum Creatinine levels in the AKI group showed no statistical significance. The Receiver Operating Characteristic (ROC) curve analysis further supported the efficacy of serum Cy
文摘Background and Aims:Rifaximin is effective in prevent-ing and treating hepatic encephalopathy(HE).This study aimed to investigate the efficacy and safety of different dosages of rifaximin in the treatment of cirrhotic patients with covert HE(CHE).Methods:In this single-center,ran-domized,controlled,open-label study,CHE was diagnosed using a combination of the psychometric HE score and the EncephalApp Stroop test.Cirrhotic patients with CHE were recruited and randomly assigned to low-dose rifaximin 800 mg/day,high-dose rifaximin(1,200 mg/day),and control groups,and were treated for 8 weeks.The sickness impact profile(SIP)scale was used to evaluate the health-relat-ed quality of life(HRQOL)of patients.Forty patients were included in the study,12 were assigned to the low-dose group,14 to the high-dose group,and 14 patients to the control group.Results:The percentage of patients with CHE reversal was significantly higher in both the low-dose(41.67%,5/12)and high-dose(57.14%,8/14)groups than in the control group(7.14%,1/14)at 8 weeks(p=0.037 and p=0.005,respectively).In addition,both doses of ri-faximin resulted in significant improvement of the total SIP score compared with the control group.There were no sig-nificant differences in the CHE reversal rate,total SIP score improvement,and incidence of adverse event between the low-dose and high-dose groups(p>0.05).Conclusions:Low-dose rifaximin reverses CHE and improves HRQOL in cirrhotic patients with comparable effects and safety to high-dose rifaximin.
文摘This single-center, randomized, and controlled intervention study compared an acrylate skin adhesive, EpinexusTM (Mitsui Chemicals, Inc., Tokyo) with Dermabond AdvancedR (Ethicon, Inc., Somerville, New Jersey). The primary endpoint was cosmetic outcome at 52 weeks after treatment (Manchester Scar Scale), and the secondary endpoints were cosmetic outcome at 4 and 26 weeks after treatment (Manchester Scar Scale), wound closure, and usability. We evaluated 59 patients (29 cases and 30 controls). Failures and adverse events were also evaluated, and 8 adverse events (5 cases and 3 controls) were reported (epidermolysis, n = 4;contact dermatitis, n = 1;eczema, n = 1;and surgical wound dehiscence, n = 2). No difference was observed between groups in cosmetic outcome at 52 and 24 weeks;however, at 4 weeks, cases showed better cosmetic outcome compared with controls. With regard to usability, the treatment duration and application time were significantly longer with EpinexusTM, and ease of application was significantly better with Dermabond AdvancedR.
基金Supported by Sichuan Provincial Key Project-Science and Technology Project Plan,No.2019yfs0372.
文摘BACKGROUND Laparoscopic liver resection(LLR)has become a safe surgical procedure that needs additional summarization.AIM To review 4 years of total LLR surgeries,exceeding 1000 cases,which were performed at a single center.METHODS Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified.Surgical details,including the interventional year,category of liver disease,and malignant liver tumors prognosis,were evaluated.The learning curve for LLR was evaluated using the cumulative sum method.The Kaplan-Meier method was used to perform survival analysis.RESULTS Ultimately,1098 patients were identified.Hepatocellular carcinoma(HCC)was the most common disease that led to the need for LLR at the center(n=462,42.08%).The average operation time was 216.94±98.51 min.The conversion rate was 1.82%(20/1098).The complication rate was 9.20%(from grade II to V).The 1-year and 3-year overall survival rates of HCC patients were 89.7%and 81.9%,respectively.The learning curve was grouped into two phases for local resection(cases 1-106 and 107-373),three phases for anatomical segmentectomy(cases 1-44,45-74 and 75-120),and three phases for hemihepatectomy(cases 1-17,18-48 and CONCLUSION LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary,secondary,and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.
文摘AIM:To investigate perioperative patient morbidity/mortality and outcome after cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS:Of 150 patients 100 were treated with cytoreductive surgery and HIPEC and retrospectively analyzed.Clinical and postoperative follow-up data were evaluated.Body mass index(BMI),age and peritoneal carcinomatosis index(PCI) were chosen as selection criteria with regard to tumor-free survival and perioperative morbidity for this multimodal therapy.RESULTS:CRS with HIPEC was successfully performed in 100 out of 150 patients.Fifty patients were excluded because of intraoperative contraindication.Median PCI was 17(1-39).In 89% a radical resection(CC0/CC1) was achieved.One patient died postoperatively due to multiorgan failure.Neither PCI,age nor BMI was a risk factor for postoperative complications/outcome according to the DINDO classification.In 9% Re-CRS with HIPEC was performed during the follow-up period.CONCLUSION:Patient selection remains the most important issue.Neither PCI,age nor BMI alone should be an exclusion criterion for this multimodal therapy.
