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Purpose@#Proctectomy for the treatment of rectal cancer results in inevitable changes to bowel habits. Symptoms such as fecal incontinence, constipation, and tenesmus are collectively referred to as low anterior resection syndrome (LARS). Among the several risk factors that cause LARS, anastomotic leakage (AL) is a strong risk factor for permanent stoma formation. Therefore, the purpose of this study was to investigate the relationship between the severity of LARS and AL in patients with rectal cancer based on the LARS score and the Memorial Sloan Kettering Cancer Center (MSKCC) defecation symptom questionnaires. @*Methods@#We retrospectively analyzed patients who underwent low anterior resection for rectal cancer since January 2010. Patients who completed the questionnaire were classified into the AL group and control group based on medical and imaging records. Major LARS and MSKCC scores were analyzed as primary endpoints. @*Results@#Among the 179 patients included in this study, 37 were classified into the AL group. After propensity score matching, there were significant differences in the ratio of major LARS and MSKCC scores of the control group and AL group (ratio of major LARS: 11.1% and 37.8%, P<0.001; MSKCC score: 67.29±10.4 and 56.49±7.2, respectively, P<0.001). Univariate and multivariate analyses revealed that AL was an independent factor for major LARS occurrence and MSKCC score. @*Conclusion@#This study showed that AL was a significant factor in the occurrence of major LARS and defecation symptoms after proctectomy.
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1,2-Diacetylbenzene (DAB) is a metabolite of 1,2-diethylbenzene, which is commonly used in the manufacture of plastics and gasoline. We examined the neurotoxic effects of DAB in young and old rats, particularly its effects on hippocampus. Previously, we reported DAB impairs hippocampal neurogenesis but that the underlying mechanism remained unclear. In this study, we evaluate the toxicities exhibited by DAB in the hippocampi of 6-month-old (young) and 20-month-old (old) male SD rats by treating animals intraperitoneally with DAB at 3 mg/kg/day for 1 week. Hippocampal areas were dissected from brains and RNA was extracted and subjected to RNA-seq analysis. RNA results showed animals exhibited age-dependent sensitivity to the neurotoxic effects of DAB. We observed that inflammatory pathways were up-regulated in old rats but that metabolism- and detoxification-related pathways were up-regulated in young rats. This result in old rats, especially upregulation of the TREM1 signaling pathway (an inflammatory response involved in Alzheimer’s disease (AD)) was confirmed by RT-PCR. Our study results provide a better understanding of age-dependent responses to DAB and new insight into the association between DAB and AD.
ABSTRACT
1,2-Diacetylbenzene (DAB) is a metabolite of 1,2-diethylbenzene, which is commonly used in the manufacture of plastics and gasoline. We examined the neurotoxic effects of DAB in young and old rats, particularly its effects on hippocampus. Previously, we reported DAB impairs hippocampal neurogenesis but that the underlying mechanism remained unclear. In this study, we evaluate the toxicities exhibited by DAB in the hippocampi of 6-month-old (young) and 20-month-old (old) male SD rats by treating animals intraperitoneally with DAB at 3 mg/kg/day for 1 week. Hippocampal areas were dissected from brains and RNA was extracted and subjected to RNA-seq analysis. RNA results showed animals exhibited age-dependent sensitivity to the neurotoxic effects of DAB. We observed that inflammatory pathways were up-regulated in old rats but that metabolism- and detoxification-related pathways were up-regulated in young rats. This result in old rats, especially upregulation of the TREM1 signaling pathway (an inflammatory response involved in Alzheimer’s disease (AD)) was confirmed by RT-PCR. Our study results provide a better understanding of age-dependent responses to DAB and new insight into the association between DAB and AD.
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Purpose@#Hand-eye discordance during laparoscopic colon surgery is an obstacle to the assistant. We evaluated the usefulness of a 180° rotatable laparoscopic monitor for the colorectal surgery assistant to overcome hand-eye discordance. @*Methods@#Twenty-six residents of the department of surgery (novice group, n=13; experienced group, n=13) participated in this study. They performed grasping a ring and transferring it to standing bars on a laparoscopic training kit under the conventional view and a 180° rotated monitor view. We defined successful performance when this procedure was completed in 3 minutes. @*Results@#The number of successful performance was higher under the 180° rotated monitor view than under the conventional view monitor (6.88±2.79 vs. 0.92±0.80, p<0.01). Under the 180° rotated monitor view, the experienced group had a higher number of successful performances than the novice group (8.31±2.59 vs. 5.46±2.26, p=0.009). However, no statistically significant difference was found between the two groups under the conventional view (1.23±0.93 vs. 0.62±0.51, p=0.091). @*Conclusion@#This study shows the usefulness of a 180° rotated monitor view to overcome hand-eye discordance, which adversely affects the laparoscopic performance of the colorectal surgery assistant.
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Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.
ABSTRACT
Actinomycosis is a rare chronic bacterial infection primarily caused by Actinomyces israelii. A 47-year-old woman presented to our clinic with a 1-week history of lower abdominal pain. Preoperative imaging studies revealed multiple peritoneal and pelvic masses suggestive of malignancy. The primary tumor could not be identified despite further endoscopic and gynecological evaluation. On exploration for tissue confirmation, excisional biopsies from multiple masses were performed because complete excision was not possible. Histopathological examination confirmed actinomycosis with multiple abscesses, and the patient was treated with antibiotics. We present a case of disseminated peritoneal actinomycosis that mimicked malignant peritoneal carcinomatosis on imaging studies.
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PURPOSE: Antithrombotic therapy could be related with nuisance bleeding. This study investigated whether vitreous hemorrhage (VH) is associated with specific types of antithrombotic medication in patients with atrial fibrillation (AF). MATERIALS AND METHODS: In the Korean National Health Insurance Service National Sample Cohort, we identified 9352 antiplatelet/anticoagulant-treated AF patients. The occurrence of VH was compared between warfarin (n=1493) and a propensity score (PS)-matched antiplatelet group (n=1493) and between warfarin (n=1493) and a PS-matched warfarin+antiplatelet group (n=1493). RESULTS: The outcomes of VH were lower in the warfarin than in the matched antiplatelet (1.45 vs. 3.72 events/1000 patient-years) and matched warfarin+antiplatelet groups (1.45 vs. 6.87 events/1000 patient-years). Compared with warfarin, the risk of VH increased with antiplatelet [adjusted hazard ratio (aHR) 3.90; 95% confidence interval (CI) 1.22–12.4, p=0.022] and warfarin+antiplatelet agents (aHR 4.39, 95% CI 1.74–11.2, p=0.002). Compared with warfarin only, warfarin+antiplatelet agents increased the risk of VH in patients ≥65 years, regardless of gender and hypertension. The risk of VH was significantly higher with dual antiplatelet therapy (aHR: 5.02, 95% CI: 1.56–16.2, p=0.007) or in dual (aHR: 5.02, 95% CI: 1.74–14.5, p=0.003) or triple therapy using warfarin and antiplatelet agents than with warfarin monotherapy (aHR: 6.12, 95% CI: 1.76–21.3, p=0.004). CONCLUSION: Dual antiplatelet or triple therapy increased the risk of VH significantly, compared to warfarin monotherapy. Considering the low efficacy of preventing ischemic stroke and high risk of bleeding, dual or triple therapy using warfarin and antiplatelet agents should be avoided to prevent VH in AF patients.
Subject(s)
Humans , Atrial Fibrillation , Cohort Studies , Hemorrhage , Hypertension , National Health Programs , Platelet Aggregation Inhibitors , Propensity Score , Stroke , Vitreous Hemorrhage , WarfarinABSTRACT
Computer aided design and manufacturing and implant surgery using a guide template improve restoration-driven implant treatment procedures. This case utilized those digital technologies to make definitive prostheses for a patient. According to the work flow of digital dentistry, cone beam computed tomography established the treatment plan, which was followed to make the guide template for implant placement. The template guided the implants to be installed as planned. The customized abutments and surveyed fixed restorations were digitally designed and made. The metal framework of the removable partial denture was cast from resin pattern using an additive manufacturing technique, and the artificial resin teeth were replaced with the zirconia onlays for occlusal stability. These full mouth rehabilitation procedures provided functionally and aesthetically satisfactory results for the patient.
Subject(s)
Humans , Computer-Aided Design , Cone-Beam Computed Tomography , Dentistry , Denture, Partial, Removable , Inlays , Mouth Rehabilitation , Mouth , Prostheses and Implants , Tooth , WorkflowABSTRACT
PURPOSE: To investigate the relationship between dominant eye and refractive error in patients with myopic anisometropia. METHODS: This study population consisted of myopes less than 15 years old who were followed up for anisometropia defined as interocular difference of spherical equivalent (SE) ≥1.0 diopter (D). All patients underwent the hole-in-the-card test at far and near to determine ocular dominance. The data were analyzed for statistical significance using Fisher's exact test. RESULTS: A total of 102 eyes in 51 patients were analyzed. The mean age of the patients was 10.4 ± 1.4 years and 54.9% were male. The mean SE was −2.97 ± 1.95 D in the right eye and −3.02 ± 1.92 D in the left eye. The right eye was the dominant eye in 43.1% and 37.3% at distance and near, respectively. The agreement of dominancy between distant and near was 82.4%. The near dominant eyes showed statistically significant accordance with more myopic eyes (p = 0.009). On the other hand, there was no statistically significant relationship between more myopic eyes and distant dominant eyes (p = 0.09). CONCLUSIONS: The near dominant eye was more myopic eye in patients with myopic anisometropia. This was considered to be related with the lag of accommodation in dominant eye with near distance.
Subject(s)
Humans , Male , Anisometropia , Dominance, Ocular , Hand , Myopia , Refractive ErrorsABSTRACT
PURPOSE: To investigate the underlying causes and clinical characteristics of patients referred with intraocular pressure (IOP) elevation. METHODS: We retrospectively reviewed the medical records of patients who were referred with IOP elevation from July 2016 to July 2017. Patients with baseline IOP ≥ 22 mmHg and those who were treated and followed up for 6 months were included. The prevalence rates of the underlying diseases that caused IOP elevation were evaluated and the clinical characteristics were compared between patients with primary and secondary glaucoma. RESULTS: A total of 127 patients were included (mean age, 59.3 ± 16.8 years; baseline IOP, 31.7 ± 10.5 mmHg). Among the study participants, 22.0%, 31.5%, and 46.5% had been diagnosed with ocular hypertension, primary glaucoma, and secondary glaucoma, respectively. Among the causes of IOP elevation, open-angle glaucoma (20.5%) had the highest prevalence rate among those with primary glaucoma and inflammation-related glaucoma (12.6%) was the most prevalent cause among those with secondary glaucoma. In a comparison between patients with primary and secondary glaucoma, the percentage of IOP reduction was not significantly different at 6 months after treatment (52.1% vs. 53.9%, p = 0.603). However, the rate of patients treated with drugs other than IOP lowering agents or who underwent surgery was significantly higher in the secondary glaucoma group compared with the primary glaucoma group (all p < 0.05). At 6-month follow-up, the secondary glaucoma group showed significantly higher improvement rates of visual acuity (p = 0.004), but had a larger proportion of patients with a visual acuity of less than or equal to finger count (p = 0.027). CONCLUSIONS: Treatment and visual outcome can vary depending on the underlying cause of IOP elevation. Therefore, a thorough examination for determining the cause of IOP elevation is recommended at the initial stage.
Subject(s)
Humans , Fingers , Follow-Up Studies , Glaucoma , Glaucoma, Open-Angle , Intraocular Pressure , Medical Records , Ocular Hypertension , Prevalence , Retrospective Studies , Visual AcuityABSTRACT
PURPOSE: Appendiceal tumors are a heterogeneous group of diseases that include typical neuroendocrine tumors (TNET), goblet cell carcinoids (GCC), and atypical GCC. Atypical GCC are classified into signet-ring cell cancers (SRCC) and poorly differentiated appendiceal adenocarcinoids. The prognosis and management of these diseases is unclear because there are no prospective studies. The aim of this study is to assess the characteristics and outcome of appendiceal TNET, GCC, and SRCC patients. MATERIALS AND METHODS: Appendiceal TNET, GCC, and SRCC patients diagnosed between 1973 and 2011 were identified in the Surveillance Epidemiology and End Results (SEER) database. Demographics, type of surgery, and clinicopathologic characteristics were collected. Survival functions were estimated by the Kaplan-Meier method, and log-rank test was used to assess the difference in overall survival (OS) among the three histologies. RESULTS: The SEER database yielded 1,021 TNET patients, 1,582 with GCC, and 534 SRCC patients. TNET presented at a younger age (p < 0.001). Patients with SRCC presented with advanced stage disease (p < 0.001). The median OS (mOS) for GCC and TNET patients was not reached; mOS for SRCC was 24 months. Multivariate analysis stratified for stage revealed significantly longer survival for TNET and GCC than SRCC (p < 0.001). CONCLUSION: This is the largest report to date for appendiceal neuroendocrine tumor patients, suggesting a spectrum of diseases with different characteristics and outcomes. In this report, we present a treatment approach for this complex spectrum of disease, based on the experience of Ohio State and Emory Universities investigators.
Subject(s)
Humans , Appendiceal Neoplasms , Carcinoid Tumor , Demography , Disease Management , Epidemiology , Goblet Cells , Multivariate Analysis , Neuroendocrine Tumors , Ohio , Prognosis , Prospective Studies , Research PersonnelABSTRACT
The diagnostic and prognostic potential of an onco-metabolite, 2-hydroxyglutarate (2HG) as a proton magnetic resonance spectroscopy (1H-MRS) detectable biomarker of the isocitrate dehydrogenase (IDH)-mutated (IDH-MT) gliomas has drawn attention of neuroradiologists recently. However, due to severe spectral overlap with background signals, quantification of 2HG can be very challenging. In this technical review for neuroradiologists, first, the biochemistry of 2HG and its significance in the diagnosis of IDH-MT gliomas are summarized. Secondly, various 1H-MRS methods used in the previous studies are outlined. Finally, wereview previous in vivo studies, and discuss the current status of 1H-MRS in the diagnosis of IDH-MT gliomas.
Subject(s)
Biochemistry , Diagnosis , Glioma , Isocitrate Dehydrogenase , Magnetic Resonance Spectroscopy , Proton Magnetic Resonance Spectroscopy , ProtonsABSTRACT
BACKGROUND: Clinical findings, medical history and laboratory findings in patients with acute pyelonephritis are insufficient to predict the occurrence of septic shock and to assess its severity and prognosis. Early imaging may not only aid in diagnosing acute pyelonephritis, but also help in assessing the risk factors associated with septic shock. METHODS: In this retrospective study, we reviewed the medical records and collected the data of 200 patients from January to December, 2011. All patients were over 18 years old; showed symptoms of fever, chills, muscle pain and flank pain; demonstrated more than 10 white blood cells in urinalysis; and were diagnosed with acute pyelonephritis after computed tomography (CT) scan. Patients were classified into two groups: patients with septic shock (group 1) and patients without septic shock (group 2), and the clinical, laboratory and CT findings of the two groups were then compared. RESULTS: Out of all 200 patients, there were 32 patients (16%) who had acute pyelonephritis with septic shock. The acute pyelonephritis with septic shock group (group 1) showed increased bacteremia compared with the other group (53.1% vs. 24.4%, p = 0.002). Laboratory findings showed that group 1 patients had higher serum creatinine (1.67 +/- 1.03 mg/dl vs. 1.14 +/- 0.98 mg/dl, p = 0.022) and hsCRP (8.36 +/- 5.29 mg/dl vs. 5.27 +/- 3.53 mg/dl, p = 0.000) than group 2 patients. The findings of kidney CT showed statistically significant differences in global renal enlargement (31.3% vs. 18.7%, p = 0.005), pelvicalyceal wall thickening (37.5% vs. 13.1%, p = 0.005) and poor excretion of contrast (25% vs. 2.4%, p = 0.000). The results of the logistic regression test showed that there were significant differences in bacteremia serum creatinine, C-reactive protein, pelvicalyceal wall thickening and poor excretion of contrast. CONCLUSIONS: Computed tomography can predict the possibility of septic shock by identifying the range of renal lesions in patients with acute pyelonephritis. It can therefore allow initial aggressive treatment that can contribute to decreases in mortality and morbidity in patients with acute pyelonephritis.