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Does reconstruction affect outcomes following exclusively endoscopic endonasal resection of benign orbital tumors: A systematic review with meta-analysis

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2022年第1期8卷 25-35页

作者： Ashton E.Lehmann Manuela von Sneidern Sarek A.Shen Ian M.Humphreys Waleed M.Abuzeid Aria Jafari Department of Otolaryngology-Head and Neck Surgery Vanderbilt University Medical CenterNashvilleTennesseeUSA Department of Otolaryngology-Head and Neck Surgery Geisinger Medical CenterDanvillePennsylvaniaUSA Department of Otolaryngology-Head and Neck Surgery New York University School of MedicineNew YorkNew YorkUSA Department of Otolaryngology-Head and Neck Surgery Johns Hopkins HospitalBaltimoreMarylandUSA Division of Rhinology and Endoscopic Skull Base Surgery Department of Otolaryngology-Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA

Objective:As exclusively endoscopic endonasal resection of benign orbital tumors has become more widespread,high-quality outcomes data are lacking regarding the decision of when and how to reconstruct the medial orbital wall following resection.The goal of this study was to systematically review pertinent literature to assess clinical outcomes relative to orbital reconstruction practices.Methods:Data Sources:PubMed,EMBASE,Web of Science.A systematic review of studies reporting exclusively endoscopic endonasal resections of benign orbital tumors was conducted.Articles not reporting orbital reconstruction details were excluded.Patient and tumor characteristics,operative details,and outcomes were recorded.Variables were compared usingχ^(2),Fisher’s exact,and independentt tests.Results:Of 60 patients included from 24 studies,34(56.7%)underwent orbital reconstruction following resection.The most common types of reconstruction were pedicled flaps(n=15,44.1%)and free mucosal grafts(n=11,32.4%).Rigid reconstruction was uncommon(n=3,8.8%).Performance of orbital reconstruction was associated with preoperative vision compromise(Poutcomes when considering all patients.In patients with intraconal tumors,however,there was a higher rate of short-term postoperative diplopia when reconstruction was foregone(P=0.041).This potential benefit of reconstruction did not persist:At an average of two years postoperatively,all patients for whom reconstruction was foregone either had improved or unchanged diplopia.Conclusion:Most outcomes assessed did not appear affected by orbital reconstruction status.This general equivalence may suggest that orbital reconstruction is not a necessity in these ca

关键词： cavernous hemangioma diplopia endoscopic endonasal surgery enophthalmos meningioma orbital reconstruction orbital tumor outcomes schwannoma

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Surgical and long-term functional outcomes of patients with Duchenne muscular dystrophy following spinal deformity correction

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World Journal of Orthopedics 2023年第6期14卷 411-426页

作者： Simon Roberts Ayesha Arshad Athanasios I Tsirikos Department of Spinal Surgery Leeds Teaching Hospitals NHS TrustLeeds LS13EXUnited Kingdom Scottish National Spine Deformity Centre Royal Hospital for Children and Young PeopleEdinburgh EH164TJUnited Kingdom

BACKGROUND Life expectancy in patients with Duchenne muscular dystrophy(DMD)has improved due to advances in medical care.DMD patients develop progressive spinal deformity after loss of ambulatory function and onset of wheelchair dependence for mobility.There is limited published data on the effect of spinal deformity correction on long-term functional outcomes,quality of life(QoL),and satisfaction in DMD patients.AIM To investigate the long-term functional outcomes following spinal deformity correction in DMD patients.METHODS This was a retrospective cohort study from 2000-2022.Data was collected from hospital records and radiographs.At follow-up,patients completed the muscular dystrophy spine questionnaire(MDSQ).Statistical analysis was performed by linear regression analysis and ANOVA to analyse clinical and radiographic factors significantly associated with MDSQ scores.RESULTS Forty-three patients were included with mean age 14.4 years at surgery.Spinopelvic fusion was performed in 41.9%of patients.Mean surgical time was 352.1 min and mean blood loss was 36%of estimated total blood volume.Mean hospital stay was 14.1 d.Postoperative complications occurred in 25.6%of patients.Mean preoperative scoliosis was 58°,pelvic obliquity 16.4°,thoracic kyphosis 55.8°,lumbar lordosis 11.1°,coronal balance 3.8 cm,and sagittal balance+6.1 cm.Mean surgical correction of scoliosis was 79.2%and of pelvic obliquity was 80.8%.Mean follow-up was 10.9 years(range:2-22.5).Twenty-four patients had died at follow-up.Sixteen patients completed the MDSQ at mean age 25.4 years(range 15.2-37.3).Two patients were bed-ridden and 7 were on ventilatory support.Mean MDSQ total score was 38.1.All 16 patients were satisfied with the results of spinal surgery and would choose surgery again if offered.Most patients(87.5%)reported no severe back pain at follow-up.Factors significantly associated with functional outcomes(MDSQ total score)included greater duration of post-operative follow-up,age,scoliosis postoperatively,correction of scoliosis,incre

关键词： Duchenne muscular dystrophy Scoliosis Surgical Functional outcomes

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Sarcopenia in pancreatic cancer:Effect on patient outcomes

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World Journal of Gastrointestinal Oncology 2022年第12期14卷 2302-2312页

作者： Moon Hyung Choi Seung Bae Yoon Department of Radiology Eunpyeong St.Mary’s HospitalCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea Division of Gastroenterology Department of Internal MedicineCollege of MedicineThe Catholic University of KoreaSeoul 03312South Korea

Pancreatic cancer is a challenging disease with an increasing incidence and extremely poor prognosis.The clinical outcomes of pancreatic cancer depend on tumor biology,responses to treatments,and malnutrition or cachexia.Sarcopenia represents a severe catabolic condition defined by the age-related loss of muscle mass and strength and affects as much as 70%of malnourished pancreatic cancer patients.The lumbar skeletal muscle index,defined as the total abdominal muscle area at the L3 vertebral level adjusted by the square of the height,is widely used for assessing sarcopenia in patients with pancreatic cancer.Several studies have suggested that sarcopenia may be a risk factor for perioperative complications and decreased recurrence-free or overall survival in patients with pancreatic cancer undergoing surgery.Sarcopenia could also intensify chemotherapyinduced toxicities and worsen the quality of life and survival in the neoadjuvant or palliative chemotherapy setting.Sarcopenia,not only at the time of diagnosis but also during treatment,decreases survival in patients with pancreatic cancer.Theoretically,multimodal interventions may improve sarcopenia and clinical outcomes;however,no study has reported positive results.Further prospective studies are needed to confirm the prognostic role of sarcopenia and the effects of multimodal interventions in patients with pancreatic cancer.

关键词： Sarcopenia Pancreatic cancer Skeletal muscle Computed tomography outcomes Survival

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Trends and outcomes of liver transplantation among older recipients in the United States

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World Journal of Transplantation 2022年第8期12卷 259-267页

作者： Kenji Okumura Joon Sub Lee Abhay Dhand Hiroshi Sogawa Gregory Veillette Devon John Ryosuke Misawa Roxana Bodin David C Wolf Thomas Diflo Seigo Nishida Department of Surgery Westchester Medical Center/New York Medical CollegeValhallaNY 10595United States

BACKGROUND The average age of recipients and donors of liver transplantation(LT)is increasing.Although there has been a change in the indications for LT over the years,data regarding the trends and outcomes of LT in the older population is limited.AIM To assess the clinical characteristics,age-related trends,and outcomes of LT among the older population in the United States.METHODS We analyzed data from the United Network for Organ Sharing database between 1987-2019.The sample was split into younger group(18-64 years old)and older group(≥65 years old).RESULTS Between 1987-2019,155758 LT were performed in the United States.During this period there was a rise in median age of the recipients and percentage of LT recipients who were older than 65 years increased(P<0.05)with the highest incidence of LT among older population seen in 2019(1920,23%).Common primary etiologies of liver disease leading to LT in older patients when compared to the younger group,were non-alcoholic steatohepatitis(16.4%vs 5.9%),hepatocellular carcinoma(14.9%vs 6.9%),acute liver failure(2.5%vs 5.2%),hepatitis C cirrhosis(HCV)(19.2%vs 25.6%)and acute alcoholic hepatitis(0.13%vs 0.35%).In older recipient group female sex and Asian race were higher,while model for end-stage liver disease(MELD)score and rates of preoperative mechanical ventilation were lower(P<0.01).Median age of donor,female sex,body mass index(BMI),donor HCV positive status,and donor risk index(DRI)were significantly higher in older group(P<0.01).In univariable analysis,there was no difference in post-transplant length of hospitalization,one-year,three-year and five-year graft survivals between the two groups.In multivariable Cox-Hazard regression analysis,older group had an increased risk of graft failure during the five-year post-transplant period(hazard ratio:1.27,P<0.001).Other risk factors for graft failure among recipients were male sex,African American race,re-transplantation,presence of diabetes,mechanical ventilation at the time of LT,higher MELD score,presence of porta

关键词： Liver transplant Elderly outcomes Hepatocellular carcinoma Nonalcohol steatohepatitis

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Impact of tacrolimus intra-patient variability in adverse outcomes after organ transplantation

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World Journal of Transplantation 2023年第5期13卷 254-263页

作者： Maria Clara Morais Maria Eduarda Soares Gabriela Costa Laura Guerra Nayana Vaz Liana Codes Paulo Lisboa Bittencourt School of Medicine Bahiana School of Medicine and Public HealthSalvador 40290-000BahiaBrazil School of Medicine Federal University of BahiaSalvador 40110-100BahiaBrazil Unit of Gastroenterology and Hepatology Portuguese HospitalSalvador 40130-030BahiaBrazil

Tacrolimus(Tac)is currently the most common calcineurin-inhibitor employed in solid organ transplantation.High intra-patient variability(IPV)of Tac(Tac IPV)has been associated with an increased risk of immune-mediated rejection and poor outcomes after kidney transplantation.Few data are available concerning the impact of high Tac IPV in non-kidney transplants.However,even in kidney transplantation,there is still a controversy whether high Tac IPV is indeed detrimental in respect to graft and/or patient survival.This may be due to different methods employed to evaluate IPV and distinct time frames adopted to assess graft and patient survival in those reports published up to now in the literature.Little is also known about the influence of high Tac IPV in the development of other untoward adverse events,update of the current knowledge regarding the impact of Tac IPV in different outcomes following kidney,liver,heart,lung,and pancreas tran-splantation to better evaluate its use in clinical practice.

关键词： Tacrolimus Intra-patient variability Rejection Organ transplantation Graft survival outcomes

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Clinical characteristics and outcomes of autoimmune pancreatitis based on serum immunoglobulin G4 levels:A single-center,retrospective cohort study

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World Journal of Gastroenterology 2023年第47期29卷 6161-6164页

作者： Fouad Jaber Khaled Elfert Saqr Alsakarneh Azizullah Beran Mohammed Jaber Manesh Kumar Gangwani Yazan Abboud Department of Internal Medicine University of Missouri-Kansas CityKansasMO 64108United States Department of Internal Medicine SBH Health SystemNew YorkNY 10457United States Department of Gastroenterology Indiana University420 University BlvdIndianapolisIN 46202United States Department of Medical Education Al Azhar University School of MedicineGaza P.O.Box 108Palestine Department of Internal Medicine The University of ToledoToledoOH 43606United States Department of Internal Medicine Rutgers New Jersey Medical SchoolNewarNJ 57873United States

Autoimmune pancreatitis(AIP)is a complex,poorly understood disease gaining increasing attention."Clinical Characteristics and Outcome of AIP Based on Serum IgG4 levels,"investigated AIP with a focus on serum immunoglobulin(Ig)G4 levels.The 213 patients with AIP were classified according to serum IgG4 levels:Abnormal(elevated)and normal.Patients with higher IgG4 levels exhibited a more active immune system and increased relapse rates.Beyond IgG4,the IgA levels and age independently contributed to relapse risk,guiding risk assessment and tailored treatments for better outcomes.However,limitations persist,such as no IgA correlation with IgG4 levels,absent data on autoantibodypositive AIP cases critical for Asian diagnostic criteria,and unexplored relapse rates in high serum IgG AIP by subtype.Genetic factors and family histories were not addressed.As the understanding and referral of seronegative AIPs increase,there's a growing need for commercially available,highly sensitive,and specific autoantibodies to aid in diagnosing individuals with low or absent serum IgG4 levels.

关键词： Autoimmune pancreatitis Relapse Immunoglobulin G Immune System,Immunoglobulin A outcomes

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Ehlers-Danlos syndrome:prevalence and outcomes in gender affirming surgery-a single institution experience

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Plastic and Aesthetic Research 2022年第1期9卷 605-613页

作者： Alireza Najafian Isabel Cylinder Breanna Jedrzejewski Craig Sineath Zbigniew Sikora Leigh H.Martin Daniel Dugi Geolani W.Dy Jens Urs Berli Division of Plastic Surgery Department of General SurgeryOregon Health&Science UniversityPortlandOR 97239USA Department of Urology Oregon Health&Science UniversityPortlandOR 97239USA

Aim:Patients with Ehlers-Danlos Syndrome(EDS)are considered to have an increased risk for wound healing complications.Surgeons may therefore be hesitant to offer elective surgeries,including gender-affirming surgeries(GAS),to EDS patients.At our center,we frequently encountered patients presenting for GAS evaluation with the co-existing diagnosis of EDS.This study aims to establish the prevalence of EDS diagnosis in our GAS patients and compare their post-operative complications to patients without EDS diagnosis.Methods:This is a single-institution retrospective case-control study on all patients who underwent GAS from 2016-2020.Data include EDS diagnosis,demographics,operation,and complications(including minor wound healing issues).Results:Of 1363 patients presenting for GAS,36(2.6%)had EDS diagnoses and were matched with 108 control patients.Major complications requiring surgical intervention in the OR occurred in 6 patients(4.2%),(2.8% EDS vs.5.4%controls;P=0.63),while 8.3% of EDS and 14% of controls required minor interventions(P=0.38).The rate of wound healing issues of any severity was 28% in EDS vs.47% in control groups(P=0.04).Conclusion:The prevalence of EDS diagnosis in our patient population is 132 times the highest reported prevalence in the general population.Wound healing issues and the need for additional post-operative interventions in the group with EDS diagnosis were not significantly different from the control group.Our findings suggest that patients with a diagnosis of EDS undergoing GAS have comparable outcomes to patients without EDS.Concerns for post-operative complications should not be a barrier to offering GAS to patients presenting with an EDS diagnosis.

关键词： Ehlers-Danlos gender transgender gender affirmation surgery outcomes

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Prediction of outcomes in Mini-Basketball Training Program for Preschool Children with Autism Using Machine Learning Models

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International Journal of Mental Health Promotion 2022年第2期24卷 143-158页

作者： Zhiyuan Sun Fabian Herold Kelong Cai Qian Yu Xiaoxiao Dong Zhimei Liu Jinming Li Aiguo Chen Liye Zou College of Physical Education Yangzhou UniversityYangzhou225127China Institute of Sports Exercise and BrainYangzhou UniversityYangzhou225127China Department of Neurology Medical FacultyOtto von Guericke UniversityMagdeburg39120Germany German Center for Neurodegenerative Diseases(DZNE) Research Group NeuroprotectionMagdeburg39120Germany Faculty of Education University of MacaoMacaoChina Exercise Psychophysiology Laboratory Institute of KEEP Collaborative InnovationSchool of PsychologyShenzhen UniversityShenzhen518060China School of Physical Education and Health East China Normal UniversityShanghai200241China

In recent years evidence has emerged suggesting that Mini-basketball training program(MBTP)can be an effec-tive intervention method to improve social communication(SC)impairments and restricted and repetitive beha-viors(RRBs)in preschool children suffering from autism spectrum disorder(ASD).However,there is a considerable degree if interindividual variability concerning these social outcomes and thus not all preschool chil-dren with ASD proﬁt from a MBTP intervention to the same extent.In order to make more accurate predictions which preschool children with ASD can beneﬁt from an MBTP intervention or which preschool children with ASD need additional interventions to achieve behavioral improvements,further research is required.This study aimed to investigate which individual factors of preschool children with ASD can predict MBTP intervention out-comes concerning SC impairments and RRBs.Then,test the performance of machine learning models in predict-ing intervention outcomes based on these factors.Participants were 26 preschool children with ASD who enrolled in a quasi-experiment and received MBTP intervention.Baseline demographic variables(e.g.,age,body,mass index[BMI]),indicators of physicalﬁtness(e.g.,handgrip strength,balance performance),performance in execu-tive function,severity of ASD symptoms,level of SC impairments,and severity of RRBs were obtained to predict treatment outcomes after MBTP intervention.Machine learning models were established based on support vector machine algorithm were implemented.For comparison,we also employed multiple linear regression models in statistics.Ourﬁndings suggest that in preschool children with ASD symptomatic severity(r=0.712,poutcomes of SC impair-ments.Furthermore,BMI(r=-0.430,p=0.028),symptomatic severity(r=0.656,poutcomes of RRBs.Statistical models predicted 59.6%of variance in

关键词： Prediction outcomes mini-basketball training program autistic children machine learning models

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Characteristics and outcomes of patients with autoimmune pancreatitis after pancreatectomy:a retrospective study

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Journal of Pancreatology 2023年第2期6卷 43-47页

作者： Bangbo Zhao Cheng Qin Tianyu Li Zeru Li Yuanyang Wang Weibin Wang Department of General Surgery State Key Laboratory of Complex Severe and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

Objective:Autoimmune pancreatitis(AIP)is a rare and special type of pancreatitis,which is often difficult to distinguish from pancreatic cancer.We aimed to discuss the clinical characteristics,operation characteristics,and therapeutic effects of AIP pa-tients who received surgical treatment based on retrospective analysis.Methods:The medical records of patients who underwent surgery at Peking Union Medical College Hospital from January 2012 to July 2021 and whose postoperative pathology was AIP were collected.Clinical symptoms,laboratory examinations,imaging features,surgical information,and prognostic data were analyzed.Results:Nineteen patients with AIP(median age 60 years old,14 males)underwent surgery,whose main indication for surgery was suspected of a malignant lesion(n=18,94.7%).Ten patients underwent pancreaticoduodenectomy,8 underwent distal pancreatectomy,and 1 underwent total pancreatectomy,the pathological result of whom were all AIP.The main postoperative complication was pancreatic fistula(n=11,57.9%),and one patient(5.3%)underwent a second operation due to gastrointestinal anastomotic bleeding.One patient(5.6%)had a recurrence of AIP,3 patients(16.7%)were treated with glucocorticoid after sur-gery,and one patient(5.6%)was treated with immunosuppressors.Conclusions:Differential diagnosis of AIP from pancreatic cancer is complex.Operation difficulty and complication incidence for patients with AIP were similar to pancreatic cancer patients.Although glucocorticoid is the first-line treatment for AIP,surgery may still be necessary for patients who are strongly suspected of a malignant lesion.

关键词： Autoimmune pancreatitis Complications outcomes Surgery

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Liver dysfunction on admission worsens clinical manifestations and outcomes of coronavirus disease 2019

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Chinese Medical Journal Pulmonary and Critical Care Medicine 2023年第3期1卷 181-187页

作者： Fangying Lu Rong Chen Kandi Xu Jie Huang Dexiang Yang Tao Bai Yusang Xie Yun Ling Kui Liu Wei Du Jiayang Yan Huihuang Lin Jian Li Yun Feng Min Zhou Yi Guo Department of Respiratory and Critical Care Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Institute of Respiratory Diseases Shanghai Jiao Tong University School of MedicineShanghai 200025China Department of Critical Medicine Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China Department of Respiratory Diseases Tongling People’s HospitalTonglingAnhui 244099China Department of Infectious Disease Wuhan Jinyintan HospitalWuhanHubei 430048China Department of Infectious Disease Shanghai Public Health Clinical CenterShanghai 200025China Department of Respiratory and Critical Care Medicine Tongji HospitalTongji Medical College of Huazhong University of Science and TechnologyWuhanHubei 430030China Clinical Research Center Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghai 200025China

Background:Liver dysfunction was common in coronavirus disease 2019(COVID-19),but its association with clinical features and poor prognosis has not been fully delineated.Our study aimed to determine the role of liver dysfunction in COVID-19 and understand the predictors for worse outcomes in patients with liver injury.Methods:We conducted this multicenter,retrospective study in five designated hospitals for COVID-19 manage-ment.Laboratory-confirmed COVID-19 patients were enrolled and classified into the normal live function group and liver dysfunction group according to liver enzymes,bilirubin,and albumin on admission,respectively.Data of baseline,clinical manifestations,and outcomes were collected and compared in the paired groups.Results:Of the 649 included COVID-19 patients,200(30.8%),69(10.6%),and 267(41.1%)patients had elevated liver enzymes,increased bilirubin,and low-level albumin,respectively.Fever,cough,and dyspnea were the most common symptoms and showed an increased proportion in the liver dysfunction group.Compared with patients in the normal liver function group,patients with liver dysfunction manifested decreased lymphocytes,higher level of leukocytes,neutrophils,inflammatory indicators,and cytokines,as well as more severe impairment in kidney function and myocardium.They were more likely to show bilateral involvement and more pulmonary lobes involved according to chest images.With increased proportion of patients who developed severe/critical conditions and needed mechanical ventilation and systemic glucocorticoid therapy,patients with liver dysfunc-tion on admission showed significantly higher in-hospital mortality.Moreover,cardiac troponin I≥1.5 ng/mL was identified as an independent mortality predictor in the elevated liver enzymes group.Conclusion:Patients with liver dysfunction on admission had worse clinical manifestation,and resulted in higher rate of severe/critical type,receiving mechanical ventilation and in-hospital mortality.

关键词： COVID-19 Liver dysfunction Clinical manifestation outcomes Mortality

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