Comparative analysis of outcomes after multiport and single-port laparoscopic colectomy in emergency situations: Is single-port laparoscopic colectomy safe and feasible?

SummaryBackground/ObjectiveAlthough consensus has been reached on the superiority of laparoscopy for a majority of conditions underlying acute abdominal pain, the safety and feasibility of single-port laparoscopic colectomy (SPLC) in emergency situations have not been determined.MethodsA prospective electronic database of all emergency patients who underwent either multiport laparoscopic colectomy (MPLC) or SPLC between April 2006 and December 2014 was used to compare the surgical outcomes of these operative methods.ResultsDuring the study period, 31 MPLCs and 76 SPLCs were performed. These two operative methods resulted in similar operating times, transfusion amounts, lengths of stay, postoperative complications, attainment of lymph nodes, and proximal and distal cut margins. However, the SPLC group had a shorter time to first flatus (2.8±1.9 days vs. 3.8±1.5 days, p=0.005), earlier reinitiation of free oral fluids (3.2±2.1 days vs. 4.4±1.8 days, p=0.002), and lesser requirement of narcotic analgesics (2.5±3.9 times vs. 4.7±4.8 times, p=0.017).ConclusionSPLC could be a safe and effective alternative to MPLC, even in emergency situations when performed by surgeons who have overcome the learning curve associated with single-port laparoscopic techniques. The tendency toward earlier returns to bowel function and decreased incidence of postoperative analgesic use would be potential benefits of SPLC in emergency situations

In Antimyosin Monoclonal Antibody in the Detection of Doxorubicin Cardiotoxicity: a Comparison with Histology and 99mTc Pyrophosphate

Recently, lllIn-antimyosin monoclonal antibidies (IllIn-AMAb) have been introduced for the diagnosis of myocardial infarction. The purpose of this study was to investigate the feasibility of using this agent for the early detection of cardiac damage induced by doxorubicin. The degree of drug induced change in the myocardium was evaluated histologically. 99mTc pyrophosphate (99mTc-PYP), known to preferentially accumulate in Adriamycin caused lesions, was used as a control radiopharmaceutical. Myocardial uptake of 111In-AMAb and 99mTc-PYP was measured in 12 controls and 10 Adriamycin treated rabbits. The results indicated the following: 1) 111In-AMAb uptake in the heart correlated well with the degree of pathology (r=O.95); 2) 99mTc-PYP uptake was also correlated with cardiac damage (r=O.77); 3) The uptake ratio (expressed as percent injected dose per gram myocardial tissue) of Adriamycin treated animals vs. controls was 2.7: 1 for 111In-AMAb and 9.2 for 99mTc-PYP nt 24 and 2 hours after intravenous injection, respectively; 4) considerable non-specific 99mTc_PYP accumulation was measured in the lungs and kidneys and was significantly higher in drug treated animals compared to controls. 111In-AMAb accumulation remained unchanged in these organs. We conclude that 111In-AMAb accurately detects cardiac toxicity induced by Adriamycin but that 99mTc_PYP still remains an acceptable agent in part because, of its availability and higher tracer concentration in the cardiac lesions

Predictors of Successful Trial without Catheter for Postoperative Urinary Retention Following Non-Urological Surgery

Purpose To investigate the success rate of trial without catheter (TWOC) for postoperative urinary retention (POUR) after non-urological surgery and to determine predictors of successful TWOC. Methods A total of 104 patients who underwent non-urological surgery and were referred to the department of urology for POUR were included in this retrospective study. All eligible patients underwent indwelling catheterization as an initial treatment and then TWOC was performed 3 to 7 days later. POUR was defined as micturition difficulty with greater than 400 mL of postvoid residual (PVR) urine volume measured by catheterization after non-urological surgery. Successful TWOC was defined as voiding with less than 100 mL of PVR urine volume. Predictive factors were identified by multivariate regression analysis. All definitions corresponded to recommendations of the International Continence Society. Results The mean age of the patients was 65.2 (range, 23 to 92) years. There were 45 male and 59 female patients. Intraoperative indwelling catheterization was performed in 69 (66.3%) patients. Mean duration of indwelling catheterization for POUR was 5.0 (range, 3.0 to 7.0) days and 83 (79.8%) patients received medication with an alpha-blocker. A successful TWOC was observed in 70 (67.4%) patients. The mean age of the patients with failure of TWOC was significantly higher than that of the patients with successful TWOC. The percentages of female patients, spinal surgery, and prone position during surgery in patients with unsuccessful TWOC were higher than in those with successful TWOC. In the multivariate logistic regression analysis, age and location of surgery (spine vs. non-spine) were the independent predictors of successful TWOC for POUR. Conclusions Our data suggest that older age and spinal surgery may be important risk factors for failure of TWOC for POUR after non-urological surgery. Thus, adequate prevention measures may be necessary for POUR after non-urological surgery, especially in patients with these risk factors

Radiolabeling of NOTA and DOTA with Positron Emitting 68Ga and

Purpose: We established radiolabeling conditions of NOTA and DOTA with a generator-produced PET radionuclide 68Ga and studied in vitro characteristics such as stability, serum protein binding, octanol/water distribution, and interference with other metal ions. Materials and Methods: Various concentrations of NOTA․3HCl and DOTA․ 4HCl were labeled with 1 mL 68GaCl3 (0.18～5.75 mCi in 0.1 M HCl) in various pH. NOTA․3HCl (0.373 mM) was labeled with 68GaCl3 (0.183～0.232 mCi/0.1 M HCl 1.0 mL) in the presense of CuCl2, FeCl2, InCl3, FeCl3, GaCl3, MgCl2 or CaCl2 (0～6.07 mM) at room temperature. The labeling efficiencies of 68Ga-NOTA and 68Ga-DOTA were checked by ITLC-SG using acetone or saline as mobile phase. Stabilities, protein bindings, and octanol distribution coefficients of the labeled compounds also were investigated. Results: 68Ga-NOTA and 68Ga-DOTA were labeled optimally at pH 6.5 and pH 3.5, respectively, and the chelates were stable for 4 hr either in the reaction mixture at room temperature or in the human serum at 37°C. NOTA was labeled at room temperature while DOTA required heating for labeling. 68Ga-NOTA labeling efficiency was reduced by CuCl2, FeCl2, InCl2, FeCl3 or GaCl3, however, was not influenced by MgCl2 or CaCl2. The protein binding was low (2.04~3.32%). Log P value of 68Ga-NOTA was -3.07 indicating high hydrophilicity. Conclusion: We found that NOTA is a better bifunctional chelating agent than DOTA for 68Ga labeling. Although, 68Ga-NOTA labeling is interfered by various metal ions, it shows high stability and low serum protein binding.한국과학재단 국가지정연구실사업 (R0A-2008-000- 20116-0) 및 원자력연구개발사업 (2007-01238

Crossed Cerebellar Diaschisis in Cerebral Infarction: Correlation of SPECT and Clinical Features

Patients with supratentorial cerebral infarction frequently show depressed metabolic activity in the contralateral cerebellar hemisphere which is known as crossed cerebellar diaschtsisfCt.D). In order to investigate the relationship between this phenomenon and the characteristics of the supratentorial lesion, we retrospectively evaluated the findings of 99mTc-HMPAO single photon emission computed tomography(SPECT) in 26 patients with a single supratentorial infarction lesion. A cerebellar asymmetry index (AIcbll), percent difference between both cerebellar hemispherestzx'Scbll],SPECT volume deficit (SVD), and magnetic resonance volume deficit (MVD) were quantitated. A CCD, defined as AIcbll >12%, was observed in 12 of the 26 patients (46.2%). No correlation was found between the ~%cbll and duration of disease, SVD, or MVD. SVD and MVD values showed no significant difference between CCD positive and negative groups (71+47ml \IS. 70+68ml and 90+84ml \IS. 67+77ml, respectively). Patients with frontoparietal lobe or deep middle cerebral artery territory infarctions showed a significantly higher incidence of CCD and lower ~%cbll values. Patients with severe hemiparesis had a higher incidence of CCD and lower ~%cbll values than those with milder or no hemiparesis (incidence, 5/5 \IS. 6/18, p=0.008; ~ %cbll,-21. 4+3.8% \IS -8. 3±11. 1%, p=O. 014). None of the 12 patients with CCD showed clinical signs of cerebellar dysfunction. In conclusion, the location rather than the extent of the lesion appears to be the major determinant for the occurrence and magnitude of CCD in stroke patients

Predictive value of progression-related gene classifier in primary non-muscle invasive bladder cancer

<p>Abstract</p> <p>Background</p> <p>While several molecular markers of bladder cancer prognosis have been identified, the limited value of current prognostic markers has created the need for new molecular indicators of bladder cancer outcomes. The aim of this study was to identify genetic signatures associated with disease prognosis in bladder cancer.</p> <p>Results</p> <p>We used 272 primary bladder cancer specimens for microarray analysis and real-time reverse transcriptase polymerase chain reaction (RT-PCR) analysis. Microarray gene expression analysis of randomly selected 165 primary bladder cancer specimens as an original cohort was carried out. Risk scores were applied to stratify prognosis-related gene classifiers. Prognosis-related gene classifiers were individually analyzed with tumor invasiveness (non-muscle invasive bladder cancer [NMIBC] and muscle invasive bladder cancer [MIBC]) and prognosis. We validated selected gene classifiers using RT-PCR in the original (165) and independent (107) cohorts. Ninety-seven genes related to disease progression among NMIBC patients were identified by microarray data analysis. Eight genes, a progression-related gene classifier in NMIBC, were selected for RT-PCR. The progression-related gene classifier in patients with NMIBC was closely correlated with progression in both original and independent cohorts. Furthermore, no patient with NMIBC in the good-prognosis signature group experienced cancer progression.</p> <p>Conclusions</p> <p>We identified progression-related gene classifier that has strong predictive value for determining disease outcome in NMIBC. This gene classifier could assist in selecting NMIBC patients who might benefit from more aggressive therapeutic intervention or surveillance.</p

Federated learning for thyroid ultrasound image analysis to protect personal information: Validation study in a real health care environment

Background: Federated learning is a decentralized approach to machine learning; it is a training strategy that overcomes medical data privacy regulations and generalizes deep learning algorithms. Federated learning mitigates many systemic privacy risks by sharing only the model and parameters for training, without the need to export existing medical data sets. In this study, we performed ultrasound image analysis using federated learning to predict whether thyroid nodules were benign or malignant. Objective: The goal of this study was to evaluate whether the performance of federated learning was comparable with that of conventional deep learning. Methods: A total of 8457 (5375 malignant, 3082 benign) ultrasound images were collected from 6 institutions and used for federated learning and conventional deep learning. Five deep learning networks (VGG19, ResNet50, ResNext50, SE-ResNet50, and SE-ResNext50) were used. Using stratified random sampling, we selected 20% (1075 malignant, 616 benign) of the total images for internal validation. For external validation, we used 100 ultrasound images (50 malignant, 50 benign) from another institution Results: For internal validation, the area under the receiver operating characteristic (AUROC) curve for federated learning was between 78.88% and 87.56%, and the AUROC for conventional deep learning was between 82.61% and 91.57%. For external validation, the AUROC for federated learning was between 75.20% and 86.72%, and the AUROC curve for conventional deep learning was between 73.04% and 91.04%. Conclusions: We demonstrated that the performance of federated learning using decentralized data was comparable to that of conventional deep learning using pooled data. Federated learning might be potentially useful for analyzing medical images while protecting patients personal information. © 2021 JMIR Medical Informatics. All rights reserved.1

Identification of MYC as an antinecroptotic protein that stifles RIPK1-RIPK3 complex formation

The underlying mechanism of necroptosis in relation to cancer is still unclear. Here, MYC, a potent oncogene, is an antinecroptotic factor that directly suppresses the formation of the RIPK1-RIPK3 complex. Gene set enrichment analyses reveal that the MYC pathway is the most prominently down-regulated signaling pathway during necroptosis. Depletion or deletion of MYC promotes the RIPK1-RIPK3 interaction, thereby stabilizing the RIPK1 and RIPK3 proteins and facilitating necroptosis. Interestingly, MYC binds to RIPK3 in the cytoplasm and inhibits the interaction between RIPK1 and RIPK3 in vitro. Furthermore, MYC-nick, a truncated form that is mainly localized in the cytoplasm, prevented TNF-induced necroptosis. Finally, down-regulation of MYC enhances necroptosis in leukemia cells and suppresses tumor growth in a xenograft model upon treatment with birinapant and emricasan. MYC-mediated suppression of necroptosis is a mechanism of necroptosis resistance in cancer, and approaches targeting MYC to induce necroptosis represent an attractive therapeutic strategy for cancer

Relationship between insulin resistance, obesity and serum prostate-specific antigen levels in healthy men

Abstract The purpose of this study was to determine the relationship between insulin resistance, obesity and serum prostate-specific antigen (PSA) levels in healthy men with serum PSA level below 4 ng mL -1 . The men included in the study cohort were 11 827 healthy male employees of the Korea Hydro and Nuclear Power Co., LTD who had undergone medical checkups including fasting glucose, fasting insulin and serum PSA between January 2003 and December 2008. Insulin resistance was calculated by homeostasis model assessment (HOMA [fasting glucose × fasting insulin]/22.5) and quantitative insulin sensitivity check index (QUICKI; 1/[log (fasting insulin) + log (fasting glucose)]). Age-adjusted body mass index (BMI) was significantly increased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI, respectively, in analysis of variance (ANOVA) test and Duncan&apos;s multiple comparison test (P &lt; 0.001), but age-adjusted serum PSA concentration was significantly decreased according to increasing quartile of insulin resistance as determined by HOMA and QUICKI (P &lt; 0.001). Age, BMI, insulin resistance by HOMA or QUICKI were significantly independent variables to serum PSA level in a multivariate linear regression analysis (P &lt; 0.001). Insulin resistance was a significant independent variable to serum PSA level along with BMI. Insulin resistance and BMI were negatively correlated with serum PSA level in healthy men. Insulin resistance was positively correlated with BMI

A test of the submentalizing hypothesis : apes' performance in a false belief task inanimate control

Financial support came from Ministry of Education, Culture, Sports, Science and Technology (K-CONNEX to FK), Japan Society for Promotion of Science (KAKENHI 26885040, 16K21108 to FK), JSPS (KAKENHI 26245069, 24000001 to SH), and European Research Council (Synergy grant 609819 SOMICS to JC).Much debate concerns whether any nonhuman animals share with humans the ability to infer others' mental states, such as desires and beliefs. In a recent eye-tracking false-belief task, we showed that great apes correctly anticipated that a human actor would search for a goal object where he had last seen it, even though the apes themselves knew that it was no longer there. In response, Heyes proposed that apes' looking behavior was guided not by social cognitive mechanisms but rather domain-general cueing effects, and suggested the use of inanimate controls to test this alternative submentalizing hypothesis. In the present study, we implemented the suggested inanimate control of our previous false-belief task. Apes attended well to key events but showed markedly fewer anticipatory looks and no significant tendency to look to the correct location. We thus found no evidence that submentalizing was responsible for apes' anticipatory looks in our false-belief task.Publisher PDFPeer reviewe