Is there a relationship between surgical proficiency and oncologic outcome of minimally invasive radical hysterectomy for early-stage cervical cancer?

Objective: Investigate the relationship between surgical proficiency and oncological outcomes of minimally invasive surgery (MIS) in the treatment of early-stage cervical cancer. Methods: This retrospective study included patients with cervical cancer stage IB1, IB2 who were treated with minimally invasive radical hysterectomy from January 2010 to Dec 2020. Patients were divided into two groups based on the year of surgery: phase 1 (from January 2010 to December 2015) and phase 2 (from January 2016 to December 2020). Oncologic outcomes were compared between the groups. Results: In total, 142 patients were included in the final analysis. 73 and 69 patients underwent surgery in phase 1 (51.4%) and phase 2 (48.6%), respectively. Twelve recurrences (12/142, 8.5%) were observed in the entire cohort: ten (13.7%) in phase 1 and two (2.9%) in phase 2. The recurrence rate was significantly higher in phase 1 (p = 0.021). And the phase 1 group showed significantly shorter disease-free survival than the phase 2 group (p = 0.049). In the multivariate analysis, surgical proficiency, represented by the phase of operation, was the only significant predictor of disease-free survival (HR = 0.244, p = 0.042). Conclusions: Surgical proficiency in MIS is a significant factor associated with the outcomes in early-stage cervical cancer. More favorable outcomes can be obtained after operating on a certain number of MIS cases.

Prognostic value of pretreatment systemic inflammatory markers in patients with stage I endometrial cancer.

Objective: Evaluate the prognostic value of monocyte-lymphocyte ratio (MLR) in patients with stage I endometrial cancer. Method: Data from 225 patients with stage I endometrioid endometrial cancer who underwent surgical resection between January 2010 and December 2020 were reviewed. The receiver operating characteristic (ROC) curves were generated for the neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and MLR. Optimal cut-off values were determined as the points at which the Youden index (sensitivity + specificity - 1) was maximal. Based on the results of the ROC curve analysis, the patients were grouped into high MLR and low MLR groups. Recurrence rate, and disease-free survival were compared between the two groups. The prognostic factors were investigated using univariate and multivariate Cox proportional hazards model. Results: The optimal cut-off value of MLR was 0.220 (AUC, 0.835; p < 0.001). Significantly more patients in the high MLR group experienced recurrence (20.3% vs. 1.9%, p < 0.0001). In multivariate analysis, grade, depth of myometrial invasion, adjuvant RT, and high MLR were independent prognostic factors for disease-free survival. Conclusion: Elevated MLR was significantly associated poor clinical outcomes in patients with stage I endometrioid endometrial cancer. Our findings suggest that MLR may be clinically reliable and useful as an independent prognostic marker for patients with stage I endometrioid endometrial cancer.

Takotsubo syndrome as an overlooked and elusive cause of a single episode of dyspnea in young women: a case report.

BACKGROUND: Dyspnea is a common symptom in patients presenting to the emergency department. It has a variety of causes that range from non-urgent to life-threatening. One episode of dyspnea in a healthy young person is easy to overlook. However, if the symptoms occur after physically or emotionally stressful events, careful evaluation needs to be undertaken because it may be associated with Takotsubo syndrome, which is rarely expected but can be fatal. Herein, we report the case of Takotsubo syndrome in a healthy young woman who arrived at the emergency department after experiencing a short single episode of dyspnea following a minor surgery. CASE PRESENTATION: A 23-year old woman with no underlying chronic disease underwent closed reduction surgery for a nasal bone fracture under general anesthesia (with sevoflurane as the anesthetic). Approximately 5 h later, she presented to the emergency department with dyspnea, which improved soon upon arrival at the emergency department. There were no other symptoms. The dyspnea occurred about 5 h after being discharged on observation, with an uneventful postoperative course. Her electrocardiogram and chest X-ray findings were unremarkable. On testing, troponin I and creatine kinase myocardial band levels were elevated at 6.122 ng/mL and 11.2 µg/L (reference ranges: 0.000-0.046 ng/mL and 0.0-5.0 µg/L), respectively. Bedside echocardiography revealed an ejection fraction of 25%, with mid-ventricular and apical akinesia and basal hyperkinesia. The pulmonary and coronary angiographic computed tomographic scans were unremarkable. Hence, apical Takotsubo syndrome was suspected. A follow-up echocardiogram taken 5 days after admission showed full recovery with a normalized ejection fraction (60%) and no regional wall motion abnormality. The patient was discharged on the sixth day with no other complications. CONCLUSION: When atypical symptoms, such as transient dyspnea, manifest, it becomes necessary to suspect and diagnose Takotsubo syndrome to ensure timely and appropriate medical management, especially when a preceding stressful event, such as minor surgery has occurred. It might be helpful to perform bedside point-of-care echocardiography to check for regional wall motion abnormalities that are typically associated with Takotsubo syndrome.

Risk Stratification of Intermediate-Risk Children With Minor Head Injury.

The Pediatric Emergency Care Applied Research Network rule helps emergency physicians identify very low-risk children with minor head injury who can forgo head computed tomography. This rule contributes to reduction in lifetime risk of radiation-induced cancers while minimizing missing clinically important traumatic brain injury. However, in intermediate-risk children, decisions on whether to perform computed tomography remain at the emergency physicians' discretion. To reduce this gray zone, this review summarizes evidence for risk stratification of intermediate-risk children with minor head injury.

Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial.

OBJECTIVE: Subcutaneous local anaesthetic injection can be painful to patients in the ED. We evaluated the effect of cryotherapy by application of an ice cube to the injection site prior to injection in patients with simple lacerations. METHODS: We conducted a prospective, randomised, controlled trial in consented patients with simple lacerations needing primary repair at a single emergency centre from April to July 2016. We randomly assigned patients undergoing repair for simple lacerations to either the cryotherapy group or the control group (standard care; no cryotherapy or other pretreatment of the injection site). In cryotherapy group subjects, we applied an ice cube (size: 1.5×1.5×1.5 cm) placed inside a sterile glove on the wound at the anticipated subcutaneous lidocaine injection site for 2 min prior to injection. The primary outcome was a subjective numeric rating (0-10 scale) of the perceived pain from the subcutaneous local anaesthetic injections. Secondary outcomes were (a) perceived pain on a numeric scale for cryotherapy itself, that is, pain from contact of the ice cube/glove with the skin and (b) the rate of complications after primary laceration repair. RESULTS: Fifty patients were enrolled, consented and randomised, with 25 in the cryotherapy group and 25 in the control group. The numeric rating scale for subcutaneous anaesthetic injections was median, IQR, 95% CI 2.0 (1 to 3.5), 1.81 to 3.47, respectively, in the cryotherapy group and 5.0 (3 to 7), 3.91 to 6.05 in the control group (Mann-Whitney U=147.50, p=0.001). No wound complications occurred in either group. The numeric rating scale for cryotherapy itself was median, IQR, 95% CI: 2.0 (1 to 3.5), 1.90 to 3.70. CONCLUSION: Pre-emptive topical injection site cryotherapy lasting 2 min before subcutaneous local anaesthetic injections can significantly reduce perceived pain from subcutaneous local anaesthetic injections in patients presenting for simple laceration repair. TRIAL REGISTRATION NUMBER: KCT0001990.

Design of Diaphragm and Coil for Stable Performance of an Eddy Current Type Pressure Sensor.

The aim of this work was to develop an eddy current type pressure sensor and investigate its fundamental characteristics affected by the mechanical and electrical design parameters of sensor. The sensor has two key components, i.e., diaphragm and coil. On the condition that the outer diameter of sensor is 10 mm, two key parts should be designed so as to keep a good linearity and sensitivity. Experiments showed that aluminum is the best target material for eddy current detection. A round-grooved diaphragm is suggested in order to measure more precisely its deflection caused by applied pressures. The design parameters of a round-grooved diaphragm can be selected depending on the measuring requirements. A developed pressure sensor with diaphragm of t = 0.2 mm and w = 1.05 mm was verified to measure pressure up to 10 MPa with very good linearity and errors of less than 0.16%.

The efficacy of pre-warming on reducing intraprocedural hypothermia in endovascular coiling of cerebral aneurysms.

BACKGROUND: The anesthetic management of patients undergoing endovascular treatment of cerebral aneurysms in the interventional neuroradiology suite can be challenged by hypothermia because of low ambient temperature for operating and maintaining its equipments. We evaluated the efficacy of skin surface warming prior to induction of anesthesia to prevent the decrease in core temperature and reduce the incidence of hypothermia. METHODS: Seventy-two patients were randomized to pre-warmed and control group. The patients in pre-warmed group were warmed 30 minutes before induction with a forced-air warming blanket set at 38°C. Pre-induction tympanic temperature (Tpre) was measured using an infrared tympanic thermometer and core temperature was measured at the esophagus immediately after intubation (T0) and recorded at 20 minutes intervals (T20, T40, T60, T80, T100, and T120). The number of patients who became hypothermic at each time was recorded. RESULTS: Tpre in the control and pre-warmed group were 36.4 ± 0.4°C and 36.6 ± 0.3°C, whereas T0 were 36.5 ± 0.4°C and 36.6 ± 0.2°C. Core temperatures in the pre-warmed group were significantly higher than the control group at T20, T40, T60, T80, T100, and T120 (P < 0.001). Compared to T0, core temperatures at each time were significantly lower in both two groups (P = 0.007 at T20 in pre-warmed group, P < 0.001 at the other times in both groups). The incidence of hypothermia was significantly lower in the pre-warmed group than the control group from T20 to T120 (P = 0.002 at T20, P < 0.001 at the other times). CONCLUSION: Pre-warming for 30 minutes at 38°C did not modify the trends of the temperature decrease seen in the INR suite. It just slightly elevated the beginning post intubation base temperature. The rate of decrease was similar from T20 to T120. However, pre-warming considerably reduced the risk of intraprocedural hypothermia. TRIAL REGISTRATION: Clinical Research Information Service (CRiS) Identifier: KCT0001320. Registered December 19th, 2014.

The importance of victim chest exposure during cardiopulmonary resuscitation: a simulation study.

BACKGROUND: During cardiopulmonary resuscitation (CPR), inaccurate positioning of the rescuer's hand might damage internal organs due to compression around the xiphoid process. OBJECTIVE: This study aimed to determine whether exposing the victim's chest during CPR would help adequate positioning of a rescuer's hand on the chest. METHODS: This simulation study included 187 participants. We gave them four photographs each of exposed chests and unexposed chests. Participants were then asked to mark a cross at the center of the chest (CoC) and at the inter-nipple line (INL), and we measured the width of participants' palms to estimate the range of hand contact with the victim's chest. Finally, we compared the position and distribution of the CoC and INL markings and analyzed whether the hand contact range on the victim's chest involved the xiphoid process. RESULTS: The participants' CoC markings were similar regardless of whether the pictures showed an exposed or unexposed chest (p = 0.638). However, the level of INL marking was significantly lower in pictures of an exposed chest (p < 0.001). When exposing the chest, the distribution of markings was narrower for both CoC (p = 0.001) and INL (p < 0.001). The proportion of CoC markings involving the xiphoid process were lower when the chest was exposed (10.7%) than when was clothed (12.3%) (p < 0.001). Similarly, INL markings involving the xiphoid process followed the same trend in exposed vs. unexposed chest images (0% vs. 1.6%, respectively). CONCLUSIONS: Exposing the chest during CPR can improve the rescuer's ability to recognize the CoC and INL, leading to more intense chest compression and reducing the risk of inaccurate compression.

Rescuer-limited cardiopulmonary resuscitation as an alternative to 2-min switched CPR in the setting of inhospital cardiac arrest: a randomised cross-over study.

BACKGROUND: The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend that chest compression be rotated every 2 min to prevent rescuer fatigue. However, the quality of chest compression using 2-min switched CPR tends to decrease rapidly due to rescuer fatigue. We aimed to compare the effectiveness of use of 2-min switched CPR and rescuer-limited CPR (the person performing compressions is allowed to switch with another rescuer prior to 2 min if feeling fatigued) in the setting of inhospital cardiac arrest. METHODS: Using a randomised cross-over trial design, 90 medical students were grouped into pairs to perform four cycles of 2-min switched CPR and rescuer-limited CPR (495 s per technique). During each trial, the total number of compressions performed, mean depth of compression and proportion of effective compressions performed (compression depth >5 mm) were recorded for identification of significant differences and changes in pulse rate and RR were measured to determine the extent of exhaustion. RESULTS: Compared with 2-min switched CPR, the mean compression was deeper (51 vs 47 mm, p<0.001), total number of compressions greater (476 vs 397, p=0.003) and proportion of effective compressions greater (56% vs 47%, p=0.004) during rescuer-limited CPR. Subgroup analysis by 30-s unit showed more consistent compression quality during rescuer-limited CPR. No significant differences in change in pulse rate and RR were found between the two techniques. CONCLUSIONS: Rescuer-limited CPR yields a greater number of effective compressions and more consistent quality of CPR than 2-min switched CPR. Rescuer-limited CPR might be a suitable alternative for treating inhospital cardiac arrest.

Postpartum hemophagocytic lymphohistiocytosis: A case report.

BACKGROUND: Postpartum hemophagocytic lymphohistiocytosis (HLH) is a rare disease with unclear pathophysiology. It is a secondary HLH diagnosed using the pediatric diagnostic criteria; however, the clinical diagnosis of postpartum HLH remains challenging. Hence, HLH may remain undiagnosed, leading to poor patient prognosis. Therefore, improvements in the accuracy of postpartum HLH diagnoses and treatments are necessary. CASE SUMMARY: We report the case of a 40-year-old female with postpartum HLH. The patient attended the postpartum care center for 3 wk after giving birth and underwent needle aspiration due to thyroid gland enlargement 11 d before an emergency department visit precipitated by fever and abdominal pain. Since no abnormal emergency room findings were noted, the patient was discharged with a prescription for broad-spectrum antibiotics. Three days later, she returned to the emergency room in a hemodynamically unstable state and was admitted to the intensive care unit with suspected sepsis or hematologic disease. The patient was treated, without effect, for sepsis using broad-spectrum antibiotics, and for suspected hematologic disease with steroid therapy. However, she died due to rapidly worsening symptoms. CONCLUSION: Rapid recognition and appropriate treatment of postpartum HLH are needed to improve the prognosis.

Pediatric Application of Cuffed Endotracheal Tube.

A young child's larynx was formerly believed to be narrowest at the cricoid level, circular in section, and funnel shaped. This supported the routine use of uncuffed endotracheal tubes (ETTs) in young children despite the benefits of cuffed ETTs, such as lower risk for air leakage and aspiration. In the late 1990s, evidence supporting the pediatric use of cuffed tubes emerged largely from anesthesiology studies, while some technical flaws of the tubes remained a concern. Since the 2000s, imaging-based studies have clarified laryngeal anatomy, revealing that it is narrowest at the glottis, elliptical in section, and cylindrical in shape. The update was contemporaneous with technical advances in the design, size, and material of cuffed tubes. The American Heart Association currently recommends the pediatric use of cuffed tubes. In this review, we present the rationale for using cuffed ETTs in young children based on our updated knowledge of pediatric anatomy and technical advances.

Accuracy of Catheter Positioning during Left Subclavian Venous Access: A Randomized Comparison between Radiological and Topographical Landmarks.

Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks.

Genotyping-by-sequencing-based QTL mapping reveals novel loci for Pepper yellow leaf curl virus (PepYLCV) resistance in Capsicum annuum.

Disease caused by Pepper yellow leaf curl virus (PepYLCV) is one of the greatest threats to pepper (Capsicum spp.) cultivation in the tropics and subtropics. Resistance to PepYLCV was previously identified in a few Capsicum accessions, but no resistance QTLs have been mapped. This study aimed to elucidate the genetics of PepYLCV resistance in C. annuum L. Augmented inoculation by the viruliferous whitefly Bemisia tabaci was used to evaluate parental lines and an F2 segregating population derived from a cross between resistant C. annuum line LP97 and susceptible C. annuum line ECW30R. Final evaluation was performed six weeks after inoculation using a standardized 5-point scale (0 = no symptoms to 4 = very severe symptoms). A high-density linkage map was constructed using genotyping-by-sequencing (GBS) to identify single-nucleotide polymorphism (SNP) markers associated with PepYLCV resistance in the F2 population. QTL analysis revealed three QTLs, peplcv-1, peplcv-7, and peplcv-12, on chromosomes P1, P7, and P12, respectively. Candidate genes associated with PepYLCV resistance in the QTL regions were inferred. In addition, single markers Chr7-LCV-7 and Chr12-LCV-12 derived from the QTLs were developed and validated in another F2 population and in commercial varieties. This work thus provides not only information for mapping PepYLCV resistance loci in pepper but also forms the basis for future molecular analysis of genes involved in PepYLCV resistance.

Oncologic safety of minimally invasive surgery in non-endometrioid endometrial cancer.

OBJECTIVE: This study was aimed to compare the oncologic outcomes of patients with non-endometrioid endometrial cancer who underwent minimally invasive surgery with the outcomes of patients who underwent open surgery. METHOD: This is a retrospective, multi-institutional study of patients with non-endometrioid endometrial cancer who were surgically staged by either minimally invasive surgery or open surgery. Oncologic outcomes of the patients were compared according to surgical approach. RESULTS: 113 patients met the inclusion and exclusion criteria. 57 underwent minimally invasive surgery and 56 underwent open surgery. Patients who underwent minimally invasive surgery had smaller tumors (median size, 3.3 vs. 5.2%, p = 0.0001) and a lower lymphovascular space invasion rate (29.8% vs. 48.2%, p = 0.045). In the overall population, the numbers and rate of recurrence were significantly higher in the open surgery group (p = 0.016). In multivariate analysis, disease stage and tumor size were associated with DFS in contrast to surgical procedure. CONCLUSION: Minimally invasive surgery showed similar survival outcomes when compared to open surgery in non-endometrioid endometrial cancer patients, irrespective of disease stage. When minimally invasive surgery is managed by expert surgeons, non-endometrioid histological subtypes should not be considered a contraindication for minimally invasive surgery.

Intra and extra pelvic multidisciplinary surgical approach of retroperitoneal sarcoma: Case series report.

BACKGROUND: Retroperitoneal sarcoma (RPS) is a rare malignancy arising from mesenchymal cells that most commonly presents as an abdominal mass and is associated with poor prognosis. Although several studies have assessed the survival benefits of wide excision, few have reported detailed methods for achieving wide excision in patients with RPS. AIM: To describe our experience with multidisciplinary surgical resection of RPS using intra- and extra-pelvic approaches. METHODS: Multidisciplinary surgery is an anatomical approach that combines intra- and extra-peritoneal access within the same surgery to achieve complete RPS removal. This retrospective review of the records of patients who underwent multidisciplinary surgery for RPS analyzed surgical and survival outcomes. RESULTS: Eight patients underwent 10 intra- and extra-pelvic surgical resections, and their median mass size was 12.75 cm (range, 6-45.5 cm). Using an intrapelvic approach, laparoscopy-assisted surgery was performed in four cases and laparotomy surgery in six. Using an extrapelvic approach, ilioinguinal and posterior approaches were used in four cases each, and the prone position and midline skin incision were shared in one. All patients' RPS masses were removed completely, and four achieved R0 resection through intra- and extra-pelvic surgery. The median estimated blood loss was 2000 mL (range, 300-20000 mL) and the median hospitalization was 12.6 d (range, 9-69 d). Reoperation was needed in two patients (one for wound necrosis and the other for bowel perforation and wound necrosis). The median overall survival rate and median progression-free survival were 64.6 and 13.7 mo, respectively. CONCLUSION: RPS is therapeutically challenging because of its location and high risk of recurrence. Therefore, intra- and extra-pelvic surgical approaches can improve the macroscopic security of the surgical margin.

The usefulness of albumin-adjusted ischemia-modified albumin index as early detecting marker for ischemic stroke.

This study was conducted to investigate whether albumin-adjusted ischemia-modified albumin index (IMA index) is more sensitive and accurate than ischemia-modified albumin (IMA) as early detection marker of ischemic stroke, and to compare IMA and IMA index in progression and non-progression of ischemic stroke. This case-control study was done at an emergency medical center of a university hospital. 52 patients with neurological symptoms were enrolled (28 Ischemic Stroke Group and 24 Non-Stroke Group). In the ROC analysis of IMA index to diagnose stroke, area under the curve (AUC) was 0.990 (cutoff value 91.4; 95% CI: 0.970-1.000; sensitivity: 96.4%; specificity 95.8%). The AUC for IMA value was 0.928 (cutoff value 98 U/ml; 95% CI 0.857-0.999; sensitivity 89.3%; specificity 88.5%). [corrected] The difference between progression (n = 12) and non-progression group (n = 16) in IMA and IMA index were statistically insignificant (p > 0.01). IMA index was more sensitive than conventional IMA value as diagnostic biomarker of stroke, however, arguable as a predictive biomarker for progression of ischemic stroke.

Factors associated with prehospital delay for acute stroke in Ulsan, Korea.

BACKGROUND: Early hospital presentation is critical in the treatment of acute ischemic stroke with thrombolysis. OBJECTIVES: The aim of this study was to investigate the factors associated with prehospital delay in acute ischemic stroke. METHODS: Data were retrospectively collected over a 1-year period from 247 acute ischemic stroke patients who presented to the emergency department (ED) within 7 days after symptom onset. To investigate the factors associated with prehospital delay, sociodemographic data, initial symptoms, risk factor, National Institutes of Stroke Scale in the ED, and use of emergency medical services (EMS) were evaluated. Univariate and multivariate analysis were used to evaluate delay factors. RESULTS: Of 247 patients (mean age 64.4 ± 12.6 years, 149 male patients), the non-delay group (≤ 2 h after symptom onset) included 45 patients (mean age 60.0 ± 13.1 years, 31 male patients) and the delay group (> 2 h after symptom onset) included 202 patients (mean age 65.4 ± 12.3 years, 118 male patients). Advanced age (odds ratio [OR] 1.056, 95% confidence interval [CI] 1.024-1.089), no consciousness disturbance at symptom onset (OR 2.938, 95% CI 1.066-8.104), presentation to ED by self (OR 3.826, 95% CI 1.580-9.624), referral from other hospital (OR 16.787, 95% CI 5.445-51.750), and worsened symptoms at the ED compared to symptom onset (OR 7.708, 95% CI 1.557-38.151) were associated with a prehospital delay. CONCLUSION: Elderly patients with progressive symptom worsening had delayed arrival, but those who used EMS or had disturbed consciousness at symptom onset had early arrival.

Point of care airway ultrasound to select tracheal tube and determine insertion depth in cleft repair surgery.

We aimed to evaluate the efficacy of using airway ultrasonography to select the correct tracheal tube size and insertion depth in pediatric patients who underwent cleft repair surgery as a way to decrease airway complications and adverse events during perioperative periods. Fifty-one patients (age < 28 months) were consecutively divided into conventional (n = 28) and ultrasound (n = 23) groups. Tracheal tube size and insertion depth were determined using the age-based formula and auscultation in the conventional group, whereas using ultrasonographic measurement of subglottic diameter with auscultation and lung ultrasonography in the ultrasound group. We evaluated the initially selected tube size, insertion depth, ventilatory indices, and the incidence of airway complications and adverse events. Tube insertion depth (median [interquartile range]) was significantly greater in the ultrasound group than in the conventional group (13.5 cm [12.5-14.0] vs 13.0 cm [11.8-13.0], P = 0.045). The number of complications and adverse events was significantly higher in the conventional group than in the ultrasound group (32.1% vs 4.3%, P = 0.013). Airway ultrasound application could reduce airway-related complications and adverse events by determining the appropriate tracheal tube size and insertion depth.

Strategies to Improve the Quality and Freshness of Human Bone Marrow-Derived Mesenchymal Stem Cells for Neurological Diseases.

Human bone marrow-derived mesenchymal stem cells (hBM-MSCs) have been studied for their application to manage various neurological diseases, owing to their anti-inflammatory, immunomodulatory, paracrine, and antiapoptotic ability, as well as their homing capacity to specific regions of brain injury. Among mesenchymal stem cells, such as BM-MSCs, adipose-derived MSCs, and umbilical cord MSCs, BM-MSCs have many merits as cell therapeutic agents based on their widespread availability and relatively easy attainability and in vitro handling. For stem cell-based therapy with BM-MSCs, it is essential to perform ex vivo expansion as low numbers of MSCs are obtained in bone marrow aspirates. Depending on timing, before hBM-MSC transplantation into patients, after detaching them from the culture dish, cell viability, deformability, cell size, and membrane fluidity are decreased, whereas reactive oxygen species generation, lipid peroxidation, and cytosolic vacuoles are increased. Thus, the quality and freshness of hBM-MSCs decrease over time after detachment from the culture dish. Especially, for neurological disease cell therapy, the deformability of BM-MSCs is particularly important in the brain for the development of microvessels. As studies on the traditional characteristics of hBM-MSCs before transplantation into the brain are very limited, omics and machine learning approaches are needed to evaluate cell conditions with indepth and comprehensive analyses. Here, we provide an overview of hBM-MSCs, the application of these cells to various neurological diseases, and improvements in their quality and freshness based on integrated omics after detachment from the culture dish for successful cell therapy.

Application of point-of-care ultrasound for different types of esophageal foreign bodies: three case reports: A CARE-compliant article.

RATIONALE: Esophageal point-of-care ultrasound (POCUS) has recently been reported as a useful, quick, safe, and simple technique to detect esophageal foreign bodies (FBs). However, case series to detect esophageal FB using POCUS have been rarely reported. Chicken bones and pills, especially, have not yet been reported as esophageal FBs. The objective of this case series was to describe the POCUS findings of 3 different materials-food, pill, and chicken bone. PATIENT CONCERNS: Case 1, a 75-year-old woman with odynophagia and neck pain occurring 30 min after eating chicken porridge; Case 2, a 32-year-old woman with neck discomfort occurring 2 h after taking a pill; Case 3, a 29-year-old woman reporting FB sensation in the neck that occurred 1 h after eating sausage and rice soup. DIAGNOSIS: Case 1. Cervical esophageal FB (chicken bone), Case 2. Cervical esophageal FB (oral pill), Case 3. Cervical esophageal FB (food). INTERVENTIONS: Case 1. POCUS, urgent esophagogastroduodenoscopy (EGD) with alligator forceps. POCUS findings; hyperechoic material (suspected FB) that did not disappear by swallowing and esophageal dilatation with pooling of secretions. Case 2. POCUS. POCUS findings; hypoechoic material (suspected FB) that did not disappear by swallowing, and esophageal bulging above the FB, especially observed in the longitudinal view. Case 3. POCUS. POCUS findings; hyperechoic material (suspected FB) with reverberation artifact that did not disappear with swallowing efforts. Prior FB esophageal bulging with persistent air-fluid level was especially observed in the longitudinal view. OUTCOMES: Case 1. FB was removed by EGD with alligator forceps. Case 2. Symptoms disappeared under observation without EGD. Follow-up POCUS revealed normalized bulging esophagus. Case 3. These symptoms improved after vomiting a large piece of food material. Three patients were discharged without complications. LESSONS: In this case series, the impacted materials were chicken bone, pill, and food. However, POCUS findings were similar (esophageal dilation, hyperechoic or hypoechoic lesion with mixed echogenic contents in food or secretion, and no change with swallowing efforts). A longitudinal view was useful to assume the presence of cervical esophageal FB in all three cases. Thus, POCUS findings could be indirect signs of a FB in the esophagus.