Robotic versus Laparoscopic Liver Resections for Colorectal Metastases: A Systematic Review and Meta-Analysis.

Colorectal cancer is the third most common cancer worldwide, and the liver is the most common localization of metastatic disease. The incidence of minimally invasive liver surgery is increasing, and robotic surgery (RLR) is believed to overcome some limitations of a laparoscopic approach (LRL). We performed a systematic review and meta-analysis of operative and short-term oncologic outcomes of the laparoscopic versus robotic-assisted liver resection for colorectal liver metastases. An online search of PubMed, Embase, Scopus, and the Cochrane databases was performed. Eight studies involving 3210 patients were considered eligible for the meta-analysis. In the LRL group, a higher conversion to open rate (12.4%) was observed compared to the RLR (6.7%; p = <0.001). 30-day mortality was 0.7% for the LRL group compared to 0.5% for the RLR group (p = 0.76). Mortality in longer periods among LLR and RLR amounted to 18.2% vs. 8.0% for 1-year mortality (p = 0.07), 34.1% vs. 26.7% for 2-year mortality (p = 0.13), and 52.3% vs. 48.3% for 3-year mortality (p = 0.46). The length of hospital stay was 5.6 ± 2.5 vs. 5.8 ± 2.1 days, respectively (p = 0.47). There were no significant differences between the incidence of individual complications in the LRL and RLR groups (p = 0.78). Laparoscopic or robotic approaches for colorectal liver metastases are comparable in terms of safety and effectiveness. There are significant advantages to robotic surgery, although there is still no long-term evidence concerning overall survival, and the number of patients operated on using RLR remains small.

Diagnostic and prognostic performance of the neutrophil-to-lymphocyte ratio in acute coronary syndromes: A meta-analysis of 90 studies including 45 990 patients.

BACKGROUND: Cardiovascular disease is a leading cause of mortality worldwide and is likely to rise. Acute coronary syndrome (ACS) is consequent on inflammation. As a common and cost-effective inflammatory biomarker, the neutrophil-to-lymphocyte ratio (NLR) may be beneficial in cardiovascular medicine. AIMS: This meta-analysis examines the diagnostic and prognostic performance of the NLR in ACS. METHODS: We systematically searched PubMed Central, Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrial.gov databases. The search spanned from databases inception to January 10, 2024. The findings were aggregated into normalized mean differences with 95% confidence intervals. RESULTS: Ninety articles, with 45 990 participants, were included. Pooled analysis of the NLR varied and was higher in ST-segment elevation myocardial infarction (STEMI) vs. non-ST-segment elevation myocardial infarction patients (4.94 ± 3.24 vs. 3.24 ± 2.74), acute myocardial infarction vs. unstable angina (4.47 ± 3.43 vs. 2.97 ± 1.58), ACS vs. stable angina (SA) (5.45 ± 4.28 vs. 2.46 ± 2.15), and ACS vs. controls (5.31 ± 4.01 vs. 2.46 ± 2.45). The NLR also was associated with ACS mortality, with survivors having lower results (3.67 ± 2.72 vs. 5.56 ± 3.93). Subanalysis showed that differences in the NLR were observed in STEMI survivors (4.28 ± 3.24 vs. 6.79 ± 3.98). Of ACS patients with major cardiovascular events (MACE) vs. without MACE, the NLR was 6.29 ± 4.89 vs. 3.82 ± 4.12. In STEMI patients, the NLR differed between those with and without MACE (6.99 ± 5.27 vs. 4.99 ± 4.12). CONCLUSIONS: The NLR is an effective tool for differentiating between different types of ACS. A high NLR is associated with ACS and increased MACE at 30 days. The NLR also appears to be a good predictor of MACE risk, at least in STEMI patients.

Effect of COVID-19 on the prevalence of bystanders performing cardiopulmonary resuscitation: A systematic review and meta-analysis.

BACKGROUND: The importance of bystander cardiopulmonary resuscitation (CPR) during out-of-hospital cardiac arrests is especially important in the context of coronavirus disease 2029 (COVID-19) because it can significantly influence survival outcomes. The objective of this meta-analysis was to examine the primary outcomes of bystander CPR during the pandemic and pre-pandemic periods. METHODS: A search was conducted in the PubMed Central, Scopus, and EMBASE databases, as well as the Cochrane Central Register of Controlled Trials database, up to December 10, 2023. In cases where the value of I² was greater than or equal to 50% or the Q-test indicated that the p-value was less than or equal to 0.05, the studies were considered to be heterogeneous. Sensitivity assessment was performed using the leave-one-out methodology. The study protocol was registered in PROSPERO with the ID number CRD42023494912. RESULTS: Twenty-five articles were included in this meta-analysis. Pooled analysis showed that bystander CPR frequency during the COVID-19 pandemic was 38.8%, compared to 44.8% for the pre-pandemic period (odds ratio: 1.04; 95% confidence interval: 0.93-1.16; p = 0.48). CONCLUSIONS: The article's conclusions indicate that the COVID-19 pandemic influenced a reduction in bystander CPR compared to the pre-pandemic period, but this difference was not statistically significant. Further research is recommended to understand attitudes, including the fears of witnesses, before performing CPR on patients with suspected or confirmed infectious diseases. The study highlights the importance of bystander intervention in emergency situations and the impact of a pandemic on public health response behaviors.

The use of andexanet alpha in the Polish setting: An interdisciplinary protocol. Expert consensus statement of the Polish Cardiac Society.

Andexanet alfa (AA) is a recombinant inactive analog of human activated factor X (FXa), effectively reversing the effects of its inhibitors - rivaroxaban and apixaban, which are available in Poland. The drug was approved for clinical use registration after the publication of the results of the ANNEXA-4 trial (Andexanet Alfa, a Novel Antidote to the Anticoagulation Effects of FXa Inhibitors 4), in which its efficacy in restoring hemostasis in life-threatening hemorrhages in patients receiving using the aforementioned anticoagulants was demonstrated. Hence, AA is now recommended for patients on apixaban or rivaroxaban therapy with massive and uncontrollable hemorrhages, including hemorrhagic strokes (HS) and gastrointestinal bleeding. Drug-specific chromogenic anti-Xa assays are generally best suited for estimating rivaroxaban and apixaban plasma levels, aside from direct assessment of their concentrations. The absence of anti-Xa activity, determined using these assays, allows us to rule out the presence of clinically relevant plasma concentrations of any FXa inhibitor. On the other hand, the dose of AA should not be modified based on the results of coagulation tests, as it depends solely on the time that elapsed since the last dose of FXa inhibitor and oon the dose and type of FXa inhibitor. AA is administered as an intravenous (i.v.) bolus, followed by an i.v. infusion of the drug. The maximum reversal of anti-Xa activity occurs within two minutes of the end of the bolus treatment, with the continuation of the continuous i.v. infusion allowing the effect to be maintained for up to two hours afterwards. Because anticoagulant activity can reappear after the infusion is completed, it is currently unclear at what point after AA administration FXa inhibitors or heparin should be re-administered. In Poland AA is starting to become available and its urgent need to administer it to patients with severe bleeding on apixaban or rivaroxaban.

The prospective validation of a scoring system to assess mucosal cleanliness during esophagogastroduodenoscopy.

BACKGROUND AND AIMS: Cleanliness of the mucosa of the upper gastrointestinal (UGI) tract is critical for performing a high-quality esophagogastroduodenoscopy (EGD). The aim of this study was to validate a recently developed UGI cleanliness scale (the Polprep: Effective Assessment of Cleanliness in Esophagogastroduodenoscopy [PEACE] system) in the detection of clinically significant lesions (CSLs) in the UGI tract. METHODS: Patients who underwent a complete diagnostic EGD were prospectively enrolled from August 2021 to October 2022. The UGI tract (esophagus, stomach, and duodenum) cleanliness was scored from 0 to 3 for each segment. The primary outcomes were the detection of CSLs and PEACE scores. RESULTS: Of 995 patients enrolled from 5 centers, adequate cleanliness (AQ; all scores ≥2) was found in 929 patients. In multivariate regression analysis, AQ was associated with the number of diagnosed CSLs (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.06-3.01; P = .03). Other factors related to CSL detection were duration of EGD (OR, 1.29, 95% CI, 1.23-1.35, P < .001), male sex (OR, 1.33, 95% CI, 1.04-1.71; P = .025), and EGD indication (dyspepsia, alarm symptoms, gastritis surveillance, other indications vs gastroesophageal reflux disease) (OR, 0.43 [95% CI, 0.31-0.6, P < .001], OR, 0.44 [95% CI, 0.28-0.67, P < .001], OR, 0.44 [95% CI, 0.25-0.76; P = .004], and OR, 0.44 [95% CI, 0.31-0.62; P < .001], respectively). Twenty-seven patients were diagnosed with UGI neoplasia, all in patients with adequate cleanliness of the UGI tract. CONCLUSIONS: Adequate cleanliness of the UGI tract as assessed with the PEACE system was associated with a significantly higher detection rate of CSLs during EGD. The relationship of this scale with UGI neoplasia detection warrants further investigation.

Predictive Performance of Neuron-Specific Enolase (NSE) for Survival after Resuscitation from Cardiac Arrest: A Systematic Review and Meta-Analysis.

The prediction of outcomes following cardiac arrest continues to provide significant difficulties. A preferred strategy involves adopting a multimodal approach, which encompasses the careful evaluation of the biomarker neuron-specific enolase (NSE). This systematic review and meta-analysis aimed to gather and summarize new and existing evidence on the prediction effect of neuron-specific enolase for survival to hospital discharge among adult patients with cardiac arrest. We searched PubMed Central, Scopus, EMBASE databases, and the Cochrane Library without language restrictions from their inceptions until 30 October 2023 and checked the reference lists of the included studies. Pooled results were reported as standardized mean differences (SMDs) and were presented with corresponding 95% confidence intervals (CIs). The primary outcome was survival to hospital discharge (SHD). Eighty-six articles with 10,845 participants were included. NSE showed a notable degree of specificity in its ability to predict mortality as well as neurological status among individuals who experienced cardiac arrest (p < 0.05). This study demonstrates the ability to predict fatality rates and neurological outcomes, both during the time of admission and at various time intervals after cardiac arrest. The use of NSE in a multimodal neuroprognostication algorithm has promise in improving the accuracy of prognoses for persons who have undergone cardiac arrest.

The Prognostic Role of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis.

This study aimed to investigate the potential prognostic role of the platelet-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). A systematic search of PubMed Central, Scopus, EMBASE, and the Cochrane Library from conception through 20 August 2023 was conducted. We used odds ratios (OR) as the effect measure with 95% confidence intervals (CIs) for dichotomous data and mean differences (MD) with a 95% CI for continuous data. If I2 was less than 50% or the p value of the Q tests was less than 0.05, a random synthesis analysis was conducted. Otherwise, a fixed pooled meta-analysis was performed. Nineteen studies fulfilled the eligibility criteria and were included in the meta-analysis. PLR was higher in MACE-positive (164.0 ± 68.6) than MACE-negative patients (115.3 ± 36.9; MD = 40.14; 95% CI: 22.76 to 57.52; p < 0.001). Pooled analysis showed that PLR was higher in AMI patients who died (183.3 ± 30.3), compared to survivors (126.2 ± 16.8; MD = 39.07; 95% CI: 13.30 to 64.84; p = 0.003). It was also higher in the ACS vs. control group (168.2 ± 81.1 vs. 131.9 ± 37.7; MD = 39.01; 95% CI: 2.81 to 75.21; p = 0.03), STEMI vs. NSTEMI cohort (165.5 ± 92.7 vs. 159.5 ± 87.8; MD = 5.98; 95% CI: -15.09 to 27.04; p = 0.58), and MI vs. UAP populations (162.4 ± 90.0 vs. 128.2 ± 64.9; MD = 18.28; 95% CI: -8.16 to 44.71; p = 0.18). Overall, our findings confirmed the potential prognostic role of the plate-let-to-lymphocyte (PLR) ratio in patients presenting with suspected acute coronary syndromes (ACS). Its use as a risk stratification tool should be examined prospectively to define its capability for evaluation in cardiovascular patients.

Systemic multiple myeloma and colonic abnormalities.

Video 1Colonic abnormalities observed in the course of systemic multiple myeloma.

Daily Changes in Channel Occupancy in the 868 MHz ISM Band.

Due to the rapid development of Internet of Things (IoT) systems operating in industrial, scientific and medical (ISM) frequency bands, many researchers have attempted to determine the amount of interference that can be expected in such systems. The basic information required for this purpose is the current occupancy of frequency channels in various geographical locations. It is known that the occupancy measurement must last long enough to allow for the detection of low duty cycle transmissions. In this paper, it is shown that fulfilling only this criterion may lead to unreliable results being obtained. In two measurement campaigns performed in two different locations, the occupancy of a selected sub-band in the 868 MHz ISM band was determined on the basis of two hour-long observations repeated several times a day. During a typical day, the ratio of the maximum and the minimum result depended on the location and reached a value of eight; however, on one day, a period of abnormally high channel usage reaching 65% was observed in the location in which typical values did not exceed 1%.

Scoring system assessing mucosal visibility of upper gastrointestinal tract: The POLPREP scale.

BACKGROUND AND AIM: The proper visibility of mucosa during esophagogastroduodenoscopy (EGD) is crucial for the detection of early upper gastrointestinal tract lesions. In contrast to colonoscopy, no validated scoring system for the assessment of upper gastrointestinal mucosal cleanliness has been developed so far. The aim of the study was to create and validate standardized grading system (POLPREP) to assess the mucosal cleanliness during EGD. METHODS: To assess the visibility of mucosa during EGD, 4-point scale was developed (0-3). Twelve operators assessed 18 images of esophagus, stomach, and duodenum twice (in 2 weeks interval). In validation round, the images and endoscopy reports of 443 EGDs performed in six centers were assessed. RESULTS: The inter-observer accordance of POLPREP was 0.8 (intra-class correlation coefficient; 0.79 consultants, 0.85 trainees). The intra-observer repeatability was 0.64 (Fleiss kappa value; 0.64 consultants, 0.64 trainees). The lesions detection rate was significantly higher in clean (scores 2 and 3; 19.7%) than in "unclean" segments (score 1; 7.7%, P = 0.049). Score 3 was associated with over three-fold higher lesion detection than score 1 (odds ratio 3.2, 95% confidence interval 1.1-9; P = 0.03). CONCLUSIONS: The proposed POLPREP scale allows for unified assessment of upper gastrointestinal tract mucosal cleanliness. The higher cleanliness scores are related with greater upper gastrointestinal pathologies detection.

Hypogelsolinemia and Decrease in Blood Plasma Sphingosine-1-Phosphate in Patients Diagnosed with Severe Acute Pancreatitis.

BACKGROUND: Acute pancreatitis (AP) is a frequent hospitalization cause of patients suffering from gastrointestinal disorders. Gelsolin has an ability to bind bioactive lipids including different sphingolipids engaged in inflammatory response. Importantly, hypogelsolinemia was observed in patients with different states of acute and chronic inflammation. AIMS: The aim of the present study was to assess the interplay of blood plasma gelsolin and blood plasma sphingosine-1-phosphate (S1P) concentration in patients diagnosed with acute pancreatitis. MATERIALS AND METHODS: To assess the concentration of gelsolin and S1P, immunoblotting and HPLC technique were employed, respectively. Additionally, the concentrations of amylase, lipase, C-reactive protein (CRP), procalcitonin (PCT) and the number of white blood cells (WBC) and platelet (PLT) were recorded. RESULTS: We found that both pGSN and S1P concentrations in the plasma of the AP patients were significantly lower (pGSN ~ 15-165 mg/L; S1P ~ 100-360 pmol/mL) when compared to the levels of pGSN and S1P in a control group (pGSN ~ 130-240 mg/L; S1P ~ 260-400 pmol/mL). Additionally, higher concentrations of CRP, WBC, amylase and lipase were associated with low level of gelsolin in the blood of AP patients. No correlations between the level of PCT and PLT with gelsolin concentration were noticed. CONCLUSION: Plasma gelsolin and S1P levels decrease during severe acute pancreatitis. Simultaneous assessment of pGSN and S1P can be useful in development of more accurate diagnostic strategies for patients with severe acute pancreatitis.

Channel Occupancy Measurements in 868 MHz ISM Band in Residential Areas.

The rapid development of Internet of Things (IoT) has led to more and more devices using ISM frequency bands. Because they are not time synchronized, medium access collisions are unavoidable. The probability of such a collision is usually reasonably low; however, it increases with the number of transmitters competing for the same frequency channel. For this reason, ISM bands' occupancy is regularly monitored by researchers. This paper presents the results of the measurement campaign during which a selected part of the 868 MHz ISM frequency band was monitored for the presence of transmissions in six locations in various residential areas in Warsaw, Poland. For the purpose of the campaign, a dedicated measurement set-up comprising a software-defined radio (SDR) module was assembled. The measurements results showed that the channel occupancy is in most cases lower than 1% with a maximum observed value of 2%. The paper presents selected characteristics of the detected signals. Additionally, distribution over time of the detected signals was used together with the Monte Carlo simulations to analyze how long idle time blocks are available for new transmitters that could be deployed in the band under testing.

Role of Preoperative Esophagogastroduodenoscopy (EGD) in Bariatric Treatment.

Background: The recommendations for routine preoperative esophagogastroduodenoscopy (EGD) in patients qualified for bariatric surgeries are still a matter of debate. The aim of this study was to analyze the pathologies on preoperative EGD in patients qualified for bariatric surgeries. Materials and Methods: This study included 222 patients, divided into two groups. The obesity group consisted of patients with obesity (BMI ≥ 40 kg/m2), for whom EGD was a routine part of the preparation for laparoscopic sleeve gastrectomy (LSG). The control group of patients with normal body weight (BMI) qualified for EGD because of gastrointestinal ailments. Results: Regarding preoperative EGD in patients qualified for bariatric surgeries, we analyzed the prevalence of endoscopic pathologies in various gastrointestinal tract segments. Patients with obesity were shown to present with esophageal pathologies significantly more often than persons in the control group (n = 23, 20.91% vs. n = 12, 10.91%, p = 0.042). The odds ratio of esophageal pathologies in patients with obesity versus the control group equaled 2.15 (95%CI: 1.01-4.59). In turn, the odds ratio of duodenal pathologies in patients from the control group was 3.31 (95%Cl: 1.16-9.47), which means that persons from this group were approximately three times more likely to be diagnosed with those pathologies compared to obese patients. Moreover, patient sex was a significant predictor of duodenal pathologies, with an odds ratio of 4.03 (95%CI: 1.53-10.61). Conclusions: Preoperative EGD can identify a broad spectrum of pathologies in obese patients, which suggests a routine examination before bariatric surgery.

Impact of Acute Pancreatic Injury on Sphingolipid Metabolism in the Salivary Glands.

Acute pancreatic injury can be related to both parenchymal (responsible for exocrine functions) and islet (mainly ß-cells, responsible for endocrine functions) damage. During embryonic development, both the salivary glands and the pancreas originate from the foregut, which explains many of the observed histological and functional similarities between these two organs. The relationship between several diseases of the pancreas and salivary glands, resulting from morphological and functional similarities, is well established. Sphingolipids constitute a class of biologically active molecules involved in numerous physiological and pathological processes, including acute pancreatitis (AP) and diabetes mellitus. However, the effect of AP on sphingolipid metabolism in the salivary glands remains uncertain. In the presented study, we examined the effect of AP and type 1 diabetes mellitus on sphingolipid metabolism in the salivary glands of rats. We demonstrated that acute pancreatic injury, related to both exocrine and endocrine functions, affects the metabolism of sphingolipids in the parotid, but not submandibular, salivary glands.

Effect of Sleeve Gastrectomy on Proprotein Convertase Subtilisin/Kexin Type 9 (Pcsk9) Content and Lipid Metabolism in the Blood Plasma and Liver of Obese Wistar Rats.

Nowadays, obesity and its complications are heavy burdens to western civilization. Surgical procedures remain one of the available therapies for obesity and obesity-associated diseases treatment. Among them, sleeve gastrectomy is the most common bariatric procedure. Despite the well-established fact that sleeve gastrectomy results in significant weight loss, some of its other divergent effects still need to be established. To fulfill this knowledge gap, we examined whether sleeve gastrectomy affects lipid metabolism in the plasma and liver of obese rats. We demonstrated that chronic high-fat diet feeding led to an increment in the level of Proprotein Convertase Subtilisin/Kexin (PCSK)-a regulator of plasma cholesterol concentration-in the liver, which was decreased after the gastrectomy. Moreover, we noticed significant increases in both plasma and liver contents of free fatty acids, diacylgycerides and triacylglycerides in the obese animals, with their reduction after the bariatric surgery. In conclusion, we revealed, presumably for the first time, that sleeve gastrectomy affects lipid metabolism in the liver of obese rats.

High-fat, high-protein, and high-carbohydrate diets affect sphingolipid profile in pancreatic steatosis in Wistar rats.

OBJECTIVES: Imbalanced diets (e.g., excessive protein, fat, and carbohydrates) may contribute to numerous disorders, such as steatosis. However, previous studies in the pancreas are scarce and limited to the evaluation of sphingolipid metabolism in the islets of Langerhans that constitute only ∼5% of the organ mass. The aim of this study was to assess the effects of high-fat, high-protein, and high-carbohydrate diets on the development of pancreatic steatosis in conjunction with sphingolipid profile in the organ. METHODS: The experiments were conducted on 40 male Wistar rats (initial age 8 wk) randomly allocated to experimental groups. After 8 wk, plasma and tissue sphingolipid levels were measured by means of high-performance liquid chromatography. Blood glucose levels were measured with a glucometer, whereas insulin concentration was determined using chemiluminescence. RESULTS: We demonstrated that a chronic feeding with three different types of improper diets exerts multifarious effects on sphingolipid metabolism in the pancreas. The most important finding of the present study was that all three diets predisposed toward the onset and development of pancreatic steatosis, as evidenced by an excessive ceramide accumulation. CONCLUSIONS: As it has been established that pancreatic steatosis is a disease with growing prevalence and possible serious complications, further investigations of the topic are warranted. The complete and precise comprehension of pancreatic steatosis pathogenesis could contribute to the invention of novel therapies for the disease.

Exploring the use of Option Grid™ patient decision aids in a sample of clinics in Poland.

BACKGROUND: Research on the implementation of patient decision aids to facilitate shared decision making in clinical settings has steadily increased across Western countries. A study which implements decision aids and measures their impact on shared decision making has yet to be conducted in the Eastern part of Europe. OBJECTIVE: To study the use of Option GridTM patient decision aids in a sample of Grupa LUX MED clinics in Warsaw, Poland, and measure their impact on shared decision making. METHOD: We conducted a pre-post interventional study. Following a three-month period of usual care, clinicians from three Grupa LUX MED clinics received a one-hour training session on how to use three Option GridTM decision aids and were provided with copies for use for four months. Throughout the study, all eligible patients were asked to complete the three-item CollaboRATE patient-reported measure of shared decision making after their clinical encounter. CollaboRATE enables patients to assess the efforts clinicians make to: (i) inform them about their health issues; (ii) listen to 'what matters most'; (iii) integrate their treatment preference in future plans. A hierarchical logistic regression model was performed to understand which variables had an effect on CollaboRATE. RESULTS: 2,048 patients participated in the baseline phase; 1,889 patients participated in the intervention phase. Five of the thirteen study clinicians had a statistically significant increase in their CollaboRATE scores (p<.05) when comparing baseline phase to intervention phase. All five clinicians were located at the same clinic, the only clinic where an overall increase (non-significant) in the mean CollaboRATE top score percentage occurred from baseline phase (M=60 %, SD=0.49; 95 % CI [57-63 %]) to intervention phase (M=62 %, SD=0.49; 95% CI [59-65%]). Only three of those five clinicians who had a statistically significant increase had a clinically significant difference. CONCLUSION: The implementation of Option GridTM helped some clinicians practice shared decision making as reflected in CollaboRATE scores, but most clinicians did not have a significant increase in their scores. Our study indicates that the effect of these interventions may be dependent on clinic contexts and clinician engagement.