Nevin Manimala

Tech Coloproctol. 2022 Sep 5. doi: 10.1007/s10151-022-02675-0. Online ahead of print.

ABSTRACT

BACKGROUND: Complex perianal fistulas are a major challenge for modern surgery since 10-35% of patients have functional problems after treatment. Sphincter-saving techniques have a wide range of efficacy (10-80%). We hypothesised that autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma is a new therapeutic strategy with enhanced cure and function preservation rates.

METHODS: Adult patients with complex cryptoglandular perianal fistulas were treated with injection of autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma around and inside the fistulous tract between May 2018 and April 2019 at the General and Emergency Surgery Operative Unit of the University Hospital “P. Giaccone” of Palermo. Fistulas were confirmed by magnetic resonance imaging. Patients completed the Short Form-36 score on quality of life and the Wexner and Vaizey scores on faecal incontinence, and they were functionally studied using a three-dimensional anorectal manometry. The clinical and functional follow-up was performed at 1 year and 2 years after surgery.

RESULTS: Nine patients (4 males, 5 females; median age 42 years [19-63 years]) with high trans-sphincteric or horseshoe fistulas were treated. The average number of previous surgeries per patient was 4.8. At 1 year follow-up, 77.7% of patients were cured, while at 2 years there was 1case of relapse. The variation in Short Form-36 score in cured patients was not significant (p = 0.0936). No statistically significant differences were found in continence scores.

CONCLUSIONS: The proposed treatment is a treatment option that preserves sphincter integrity and function, potentially avoiding postoperative incontinence and the need of repeated treatments.

PMID:36063257 | DOI:10.1007/s10151-022-02675-0

Int Ophthalmol. 2022 Sep 5. doi: 10.1007/s10792-022-02484-2. Online ahead of print.

ABSTRACT

PURPOSE: Strabismus, whether congenital or acquired, is a common visual and cosmetic problem, especially for the young. Adjustable suture strabismus surgery is not in vogue in our country. This technique gives the surgeon a second attempt to provide a better outcome for the patients. Our objective was to assess the long-term success of adjustable strabismus surgery in terms of postoperative alignment.

METHODS: We carried out a prospective study utilizing the fornix approach for adjustable strabismus surgery, in mainly horizontal, but also vertical strabismus in adults and cooperative children, to enhance the postoperative outcomes. The patient characteristics, preoperative deviation, type and pattern of strabismus, were evaluated and analyzed. The postoperative alignment was evaluated at 1 year and beyond, to assess the success of this adjustable surgery.

RESULTS: This study recruited 50 adults and children with a female predominance of 39 (78%); and with the mean age being 18.34 ± 9.88 years. Exotropia was the primary diagnosis in the majority with 21 (42%) cases; with purely horizontal strabismus in 23 (46%) cases. The mean preoperative horizontal deviation was 48.76 ± 20.35 prism diopters (PD) and the mean postoperative horizontal deviation was 2.73 ± 3.63 PD. The mean preoperative vertical deviation was 4.8 ± 8.54 PD whereas the mean postoperative vertical deviation was 0.86 ± 1.73 PD. The Wilcoxon Signed Ranks test analyzed the difference between the two which was statistically significant (p = 0.000). Surgical success, defined as postoperative horizontal alignment within ≤ 10 PD of orthotropia at the end of one year or more of follow-up after surgery, was achieved in 49 (98%) cases. The average follow-up was 21.47 ± 8.7 months.

CONCLUSION: Adjustable strabismus surgery has very good long-term outcomes in terms of postoperative alignment and patient satisfaction.

PMID:36063247 | DOI:10.1007/s10792-022-02484-2

J Mol Model. 2022 Sep 5;28(10):293. doi: 10.1007/s00894-022-05267-9.

ABSTRACT

Quantum tunneling of the ammonia inversion motion and energy level splittings in He and Ar clusters were investigated. It was found that the double well potential (DWP) in He clusters is symmetrical and that the first layer of He atoms is able to model the system. The calculated tunneling splitting was in good agreement with the experimental, 36.4 and 24.6 cm[Formula: see text] respectively. For NH[Formula: see text] in Ar clusters, the DWP becomes slightly asymmetric, which is enough to decrease the resonance and make the symmetric DWP unable to model the system. An asymmetric potential was used and the result was in excellent agreement with the experimental splitting, of 9.0 and 10.6 cm[Formula: see text] respectively. Non-covalent interactions revealed that the asymmetry is caused by dissimilar interactions in each minimum of the double well potential. The effects of different methodologies were analyzed via a design of experiments approach. For the gas-phase NH[Formula: see text] molecule, only diffuse functions were statistically significant while for the NH[Formula: see text] embedded in He cluster both the MP2 method and polarization functions were significant. This tendency suggests higher order polarization functions may be essential to generate accurate barrier heights.

PMID:36063224 | DOI:10.1007/s00894-022-05267-9

J Cancer Res Clin Oncol. 2022 Sep 5. doi: 10.1007/s00432-022-04336-z. Online ahead of print.

ABSTRACT

INTRODUCTION: Recent developments in genomic sequencing have led to the identification of somatic mutations in isocitrate dehydrogenase 1 (IDH1) in various malignancies. IDH1 R132H is the most common mutation of IDH1, which affects codon 132 and results in the conversion of amino acid residue arginine (R) to histidine (H). This study is designed to evaluate the association between the expression of IDH1 R132H and clinicopathological characteristics in laryngeal squamous cell carcinoma (LSCC).

METHODS: The expression pattern and clinical significance of IDH1 R132H were investigated in tissue microarrays (TMAs) of 50 LSCC tumors as well as adjacent normal tissues using immunohistochemistry. Then the exons of the 12 tumor samples with negative/weak positive staining were sequenced by applying polymerase chain reaction (PCR).

RESULTS: The results demonstrated that the cytoplasmic expression of IDH1 R132H was downregulated in tumor cells compared to adjacent normal tissues. A statistically significant association was found between a low level of cytoplasmic expression of IDH1 R132H protein and an increase in histological grade (p < 0.001), perineural invasion (p = 0.019), and lymph node involvement (p < 0.001). The exon4 sequencing results showed that only one sample was positive for IDH1 R132H mutation. IDH1 R132H expression was observed in 39 (78.0%) LSCC samples.

CONCLUSION: These findings indicate that low cytoplasmic expression of IDH1 R132H may have clinical significance in LSCC patients and is associated with more aggressive tumor behavior and progression of the disease, which can help improve potential treatment in patients with LSCC. Further investigations are needed to understand the biological function of IDH1 R132H and larger sample size to confirm our findings.

PMID:36063222 | DOI:10.1007/s00432-022-04336-z

Neurosurg Rev. 2022 Sep 5. doi: 10.1007/s10143-022-01855-8. Online ahead of print.

ABSTRACT

Meningioangiomatosis (MA) is a disease that is extremely rarely reported. Sporadic MA is occasionally combined with meningioma or other lesions (identified as non-pure MA). This retrospective study investigated the difference between pure MA and non-pure MA by exploring clinical manifestations, histopathology characteristics, and outcomes of MA after surgery. We reviewed the medical records of 36 histopathologically confirmed MA patients (18 pure MA and 18 non-pure MA) who received surgery at our institution between 2012 and 2021. We compared differences in demographic, clinical, imaging, pathological features, and surgical outcomes between pure MA and non-pure MA through descriptive statistics. Compared to non-pure MA, pure MA presented with a more prominent male predilection (5:1 vs. 1.57:1, P = 0.264), a higher seizure incidence (83.3% vs 50.0%, P = 0.038), a more seizure type of GTCS (14/15 vs 5/9, P = 0.047), a less prominent enhancement on MRI (27.8% vs 88.9%, P < 0.001) and a preference of temporal and frontal lobe (100% vs 44.4%, P < 0.001). The differences in clinical characteristics between pure MA and non-pure MA demonstrate their disparate biological natures. Pure MA seems to be a non-neoplastic lesion, while non-pure MA is commonly combined with meningioma, which is a neoplastic lesion. A correct differential diagnosis can be achieved via a triad of the type of seizure, the location of lesion and the radiological presentation. MA is curable and the prognosis is excellent as most patients are free of seizure and recurrence after surgical treatment.

PMID:36063221 | DOI:10.1007/s10143-022-01855-8

Biol Cybern. 2022 Sep 5. doi: 10.1007/s00422-022-00941-w. Online ahead of print.

ABSTRACT

Fifty years ago, Wilson and Cowan developed a mathematical model to describe the activity of neural populations. In this seminal work, they divided the cells in three groups: active, sensitive and refractory, and obtained a dynamical system to describe the evolution of the average firing rates of the populations. In the present work, we investigate the impact of the often neglected refractory state and show that taking it into account can introduce new dynamics. Starting from a continuous-time Markov chain, we perform a rigorous derivation of a mean-field model that includes the refractory fractions of populations as dynamical variables. Then, we perform bifurcation analysis to explain the occurrence of periodic solutions in cases where the classical Wilson-Cowan does not predict oscillations. We also show that our mean-field model is able to predict chaotic behavior in the dynamics of networks with as little as two populations.

PMID:36063212 | DOI:10.1007/s00422-022-00941-w

Int Urogynecol J. 2022 Sep 5. doi: 10.1007/s00192-022-05285-4. Online ahead of print.

ABSTRACT

INTRODUCTION AND HYPOTHESIS: Prolapse is a common condition seen in women and its therapeutical management consists first and foremost of surgery. Postoperative pain is one of the most common side effects seen after surgery. The objective of this study was to identify risk factors for postoperative pain after cystocele repair with mesh.

METHODS: This is a secondary analysis of the multicenter randomized trial PROSPERE, which compared cystocele repair with mesh according to the vaginal or laparoscopic approach. The presence of postoperative pain was assessed by a pain-specific self-reported questionnaire (Questionnaire de Baudelocque). The statistical analysis is based on the Wilcoxon, Chi-squared, and Fisher’s tests.

RESULTS: The prevalence of postoperative pain (pain persisting more than 6 months) was 39% (80 out of 205, 95% CI 32.4-46.1), with 6.3% (13 out of 205) of chronic pain reports. Preoperative pain was the only statistically significant risk factor OR = 2.32 (p = 0,007; 95% CI 1.24-4.36).

CONCLUSIONS: Surgeons must be careful with preoperative painful prolapse and should inform their patient of the risk of developing postoperative chronic pain.

PMID:36063194 | DOI:10.1007/s00192-022-05285-4

Skeletal Radiol. 2022 Sep 5. doi: 10.1007/s00256-022-04170-x. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the MRI findings between the localized- and diffuse-type tenosynovial giant cell tumors (TSGCTs) of digits with pathology correlation.

METHODS: Twenty-eight patients with newly diagnosed TSGCTs of digits (22 localized and 6 diffuse types) who underwent preoperative MRI and surgical excision were included from Jan. 2015 to September 2021. MRI findings regarding nodularity, margins, morphology of hypointensity with pathology correlation, and disease extent (bone erosion, articular involvement, muscle involvement, tendon destruction, and neurovascular encasement) were assessed.

RESULTS: Diffuse type was significantly larger (P = 0.006), more multinodular on both MRI and pathology (P = 0.038, both) with significant agreement, and infiltrative on both MRI and pathology (P < 0.001, both) with substantial agreement, and showed central granular on MRI and strong hemosiderin deposition on pathology (P = 0.022 and P = 0.021) with moderate agreement than localized type. Localized type showed significantly more frequent peripheral capsules on both MRI and pathology (P < 0.001, both) with moderate agreement than diffuse type. However, the septum on both MRI and pathology showed no statistically significant difference between the two groups (P = 0.529 and P = 0.372) without significant agreement. The disease extent was more severe in the diffuse type than the localized type regarding articular involvement (P < 0.001), muscle involvement (P < 0.001), and tendon destruction (P = 0.010). No statistically significant differences were found between the two groups regarding bone erosion (P = 0.196) or neurovascular bundle encasement (P = 0.165).

CONCLUSIONS: Diffuse-type TSGCTs of digits presented as locally aggressive lesions with larger, multinodular, infiltrative masses exhibiting stronger hemosiderin deposition and more severe disease extents of articular, muscle, and tendon involvement than the localized type.

PMID:36063189 | DOI:10.1007/s00256-022-04170-x

Eval Rev. 2022 Sep 5:193841X221118454. doi: 10.1177/0193841X221118454. Online ahead of print.

ABSTRACT

Methods for estimating causal impact aim to either remove or reduce bias. This study estimates the degree of bias reduction obtained from regression adjustment and propensity score methods when only a weak set of predictors are available. The study uses an experimental test of providing emergency financial assistance to participants in a job training program to estimate an experimental benchmark and compares it to nonexperimental estimates of the impact of receiving assistance. When estimating the impact of receiving assistance, those who received it constitute the treatment group. The study explores two different comparison groups: those who could have (because they were assigned to the experimental treatment group) but did not receive emergency assistance; and those who could not receive emergency assistance because they were randomly assigned to the experimental control group. It uses these groups to estimate impacts by applying three estimation strategies: unadjusted mean comparison, regression adjustment, and inverse propensity weighting. It then compares these estimates to the experimental benchmark using statistical tests recommended by the within-study comparison literature. The nonexperimental approaches to addressing selection bias suggest large positive impacts. These are statistically different from the experimental benchmark, which shows that receipt of emergency assistance does not improve educational progress. Further, over 90% of the bias from a simple comparison of means remains. Unless a stronger set of predictors are available, future evaluations of such interventions should be wary of relying on these methods for either unbiased estimation of impacts or bias reduction.

PMID:36063140 | DOI:10.1177/0193841X221118454

J Int Adv Otol. 2022 Sep;18(5):388-391. doi: 10.5152/iao.2022.21496.

ABSTRACT

BACKGROUND: A comparative study of 1.5T and 3.0T magnetic resonance imaging inner ear gadolinium enhancement was carried out to further explore the practicality and universality of 1.5T magnetic resonance imaging in the diagnosis of inner ear labyrinthine hydrops positive imaging.

METHODS: This dual case-control study was conducted on 25 patients with Meniere’s disease (experimental group), diagnosed by People’s Hospital of Ordos Dongsheng District between April 2017 and April 2019 and 51 patients with Meniere’s disease (control group), diagnosed by People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine between March 2010 and February 2011 and published on Chinese Medical Journal in 2011. Both groups were injected with gadolinium diluent into bilateral tympanic chambers through the tympanic membrane, and 3 dimensional-Fluid Attenuated Inversion Recovery (FLAIR) magnetic resonance imaging scanning of the inner ear was performed 24 hours later. The results of the 2 groups were observed, calculated, and statistically processed.

RESULTS: The positive rate of membranous labyrinthine hydrops was 96% (24/25) in the experimental group and 96.1% (49/51) in the control group. The results are very close.

CONCLUSION: In clinical diagnoses of Meniere’s disease, 1.5T magnetic resonance imaging and 3.0T magnetic resonance imaging have the same value and significance.

PMID:36063094 | DOI:10.5152/iao.2022.21496