ABSTRACT
BACKGROUND: The aim of this meta-analysis is to investigate the safety of outpatient thyroidectomy based on 24-h and same-day discharge criteria. METHODS: CENTRAL, Embase, PubMed, and Scopus were searched. A meta-analysis of selected studies was performed. The review was registered prospectively with PROSPERO (CRD42022361134). RESULTS: Thirty-one studies met the eligibility criteria, with a total of 74328 patients undergoing thyroidectomy in an outpatient setting based on 24-h discharge criteria. Overall postoperative complications after outpatient thyroidectomies were 5.7% (95%CI: 0.049-0.065; I2 â= â97.3%), consisting of hematoma (0.4%; 95%CI: 0.003-0.005; I2 â= â83.4%), recurrent laryngeal nerve injury (0.4%; 95%CI: 0.003-0.006; I2 â= â93.5%), and hypocalcemia (1.6%; 95%CI: 0.012-0.019; I2 â= â93.7%). The rate of readmission was 1.1% (95%CI: 0.007-0.015; I2 â= â95.4%). Results were similar for same-day criteria. CONCLUSIONS: Our analysis demonstrated that outpatient thyroidectomy is a safe procedure in the management of thyroid disease for selected patients.
ABSTRACT
BACKGROUND: Laparoscopic surgery is considered a standard treatment for benign adrenal tumors; however, no consensus has been reached on the optimal resection technique for adrenocortical carcinomas. This study aims to evaluate the safety and efficacy of laparoscopic surgery and open surgery in the management of adrenocortical carcinoma. METHODS: The Cochrane, Embase, PubMed, Scopus, and Web of Science databases were searched for articles from inception to May 2022, by two independent reviewers using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The review was registered prospectively on the PROSPERO database (CRD42022316050). RESULTS: From 183 studies screened, 11 studies met the eligibility criteria, with a total of 1617 patients with adrenocortical carcinoma undergoing either laparoscopic surgery (n = 472) or open surgery (n = 1145). Open surgery demonstrated a lower rate of positive resection margin compared with laparoscopic surgery (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.10-2.10; I2 = 0%). Additionally, open surgery had more favorable overall survival (OR 0.56, 95% CI 0.44-0.72; I2 = 0%) and recurrence-free rates (OR 0.60, 95% CI 0.42-0.85; I2 = 38%) than laparoscopic surgery at 3 years. Hospital stay was shorter for laparoscopic surgery than open surgery (mean difference - 2.49 days, 95% CI - 2.95 to - 2.04; I2 = 45%). CONCLUSIONS: Open surgery should still be considered the standard operative approach; however, laparoscopic surgery could be regarded as an effective and safe operation for selected adrenocortical carcinoma cases with appropriate laparoscopic expertise. Further randomized controlled studies with tumor stage- and resection margin-dependent survival analysis are necessary to ascertain the safety and efficacy of the treatment.
Subject(s)
Adrenal Cortex Neoplasms , Adrenocortical Carcinoma , Laparoscopy , Humans , Adrenocortical Carcinoma/surgery , Margins of Excision , Laparoscopy/methods , Adrenal Cortex Neoplasms/surgery , Treatment OutcomeABSTRACT
BACKGROUND AND OBJECTIVES: Sarcopenia, which is subclinical loss of skeletal muscle mass, is commonly observed in patients with malignancy. The objective of this study is to determine the correlation between sarcopenia and operative complications following pancreatectomy for cancer. METHODS: A retrospective review of a pancreatectomy database was performed. The Hounsfield Unit Average Calculation (HUAC) of the psoas muscle, a marker of muscle density and fatty infiltration, was measured from preoperative CT scans. Complications were graded and multivariate logistic regression analysis was performed. RESULTS: One hundred eighteen patients met criteria for analysis; the overall morbidity rate was 78.8% (n = 93). There were 31 (26.3%) patients who met criteria for sarcopenia using the HUAC. When analyzed as a continuous variable, sarcopenia was an independent predictor of major grade III complications, length of stay, intensive care unit admission, delayed gastric emptying, and infectious, gastrointestinal, pulmonary, and cardiac complications. CONCLUSIONS: These data suggest that sarcopenia as measured with the HUAC, a value that can be obtained from a preoperative CT scan, is a significant independent predictor of surgical outcome and can be used to improve patient selection and informed consent prior to pancreatectomy in patients with cancer.
Subject(s)
Adenocarcinoma/surgery , Pancreatectomy , Pancreatic Neoplasms/surgery , Postoperative Complications/etiology , Sarcopenia/complications , Blood Transfusion , Female , Gastric Emptying , Humans , Intensive Care Units/statistics & numerical data , Jejunostomy , Length of Stay , Male , Retrospective StudiesABSTRACT
It is widely believed that long-term depression (LTD) and its counterpart, long-term potentiation (LTP), involve mechanisms that are crucial for learning and memory. However, LTD is difficult to induce in adult cortex for reasons that are not known. Here we show that LTD can be readily induced in adult cortex by the activation of NMDA receptors (NMDARs), after inhibition of glutamate uptake. Interestingly there is no need to activate synaptic NMDARs to induce this LTD, suggesting that LTD is triggered primarily by extrasynaptic NMDA receptors. We also find that de novo LTD requires the activation of NR2B-containing NMDAR, whereas LTP requires activation of NR2A-containing NMDARs. Surprisingly another form of LTD, depotentiation, requires activation of NR2A-containing NMDARs. Therefore, NMDARs with different synaptic locations and subunit compositions are involved in various forms of synaptic plasticity in adult cortex.
Subject(s)
Cerebral Cortex/physiology , Long-Term Potentiation/physiology , Long-Term Synaptic Depression/physiology , Receptors, N-Methyl-D-Aspartate/physiology , 2-Amino-5-phosphonovalerate/pharmacology , Animals , Aspartic Acid/pharmacology , Cerebral Cortex/drug effects , Dicarboxylic Acids/pharmacology , Dizocilpine Maleate/pharmacology , Excitatory Amino Acid Agonists/pharmacology , Excitatory Amino Acid Antagonists/pharmacology , Excitatory Postsynaptic Potentials/drug effects , Glutamic Acid/pharmacology , Long-Term Potentiation/drug effects , Long-Term Synaptic Depression/drug effects , N-Methylaspartate/pharmacology , Neurons/drug effects , Neurons/physiology , Neurons/ultrastructure , Neurotransmitter Uptake Inhibitors/pharmacology , Phenols/pharmacology , Picrotoxin/pharmacology , Piperidines/pharmacology , Protein Subunits , Pyrrolidines/pharmacology , Quinoxalines/pharmacology , Rats , Receptors, Metabotropic Glutamate/drug effects , Receptors, N-Methyl-D-Aspartate/drug effectsABSTRACT
During development neuronal circuitries are refined by activity. Here we studied the role of spontaneous electrical activity in the regulation of synapse formation in the intact newborn (Postnatal Day 3; P3) rat hippocampus in vitro. The blockade of the spontaneous network activity with TTX led to an increase in the number of functional excitatory synapses in the CA3 area of the developing hippocampus. In parallel, there was a substantial increase in the expression levels of the presynaptic markers synaptophysin, synaptotagmin, and synapsin I and of GluR1 AMPA receptor subunits. These changes were associated with an increase in the frequency and amplitude of AMPA receptor-mediated miniature excitatory postsynaptic currents (mEPSCs). Our correlated immunocytochemical, electronmicroscopical, and electrophysiological experiments indicate that in the developing hippocampus spontaneous network activity controls the number of functional synapses.
