Prophylactic Use of Antibiotics for Fever After Drainage Removal Following a Dural Tear During Lumbar Spinal Surgery: A Retrospective Study.

BACKGROUND Dural tear and subsequent cerebrospinal fluid leakage are frequent complications during lumbar spine surgery. This retrospective study aimed to investigate the risk factors and the use of prophylactic antibiotics in patients with fever after drainage removal (FDR) following lumbar dural tear during lumbar spinal surgery. MATERIAL AND METHODS The authors retrospectively analyzed 2812 patients who underwent different spinal surgical procedures from January 2015 to December 2017. The basic information of patients was obtained to analyze the risk factors of dural tear and FDR. The patients were divided into 5 groups according to their antibiotic strategies for FDR (no antibiotics, ceftriaxone, vancomycin, ceftriaxone+vancomycin, other antibiotics). Body temperature, laboratory test results, and pathogen profiles were collected for analysis. RESULTS There were 326 cases diagnosed as dural tear, including 198 cases of FDR. Sex, age, type of disease, and previous lumbar surgery played significant roles in the dural tear rate (P<0.05). Patients older than 60 years old had a higher incidence of FDR after dural tear (P<0.05). There was no significant difference in the incidence of surgical site infection among the various treatment groups (P>0.05). CONCLUSIONS Age has obvious effect on dural tear and FDR, whereas sex, revision surgery, primary diagnosis, and procedure type only affect the rate of dural tear. The prophylactic use of antibiotics has no effect on the incidence of surgical site infection when fever after drainage removal occurred in patients with dural tear.

Contactless AC/DC Wide-Bandwidth Current Sensor Based on Composite Measurement Principle.

With the accelerated construction of the smart grid, new energy sources such as photovoltaic and wind power are connected to the grid. In addition to power frequency, the current signal of power grid also includes several DC signals, as well as medium-high and high-frequency transient signals. Traditional current sensors for power grids are bulky, have a narrow measurement range, and cannot measure both AC and DC at the same time. Therefore, this paper designs a non-intrusive, AC-DC wide-bandwidth current sensor based on the composite measurement principle. The proposed composite current detection scheme combines two different isolation detection technologies, namely tunneling reluctance and the Rogowski coil. These two current sensing techniques are complementary (tunneling magnetoresistive sensors have good low-frequency characteristics and Rogowski coils have good high-frequency characteristics, allowing for a wide detection bandwidth). Through theoretical and simulation analysis, the feasibility of the composite measurement scheme was verified. The prototype of composite current sensor was developed. The DC and AC transmission characteristics of the sensor prototype were measured, and the sensitivity and linearity were 11.96 mV/A, 1.14%, respectively. Finally, the sweep current method and pulse current method experiments prove that the designed composite current sensor can realize the current measurement from DC to 17 MHz.

Genome-Wide Characterization of Chrysanthemum indicum Nuclear Factor Y, Subunit C Gene Family Reveals the Roles of CiNF-YCs in Flowering Regulation.

Nuclear Factor Y, Subunit C (NF-YC) transcription factors are conserved in most plants, and play essential roles in plant growth and development, especially in flowering regulation. Chrysanthemums are important commercial plants, and their market value is strongly impacted by flowering time. Until now, no details regarding the NF-YC family in the Chrysanthemum genus have been available. In this study, five NF-YC genes were cloned from Chrysanthemum indicum. Multiple alignments showed that CiNF-YCs had the highly conserved characteristic regions. Phylogenetic analyses identified a pair of paralogue NF-YC proteins in chrysanthemums. Gene structure and conserved motifs were also analyzed for functional understanding. According to the results of the expression experiments, CiNF-YC1 and CiNF-YC5 were mainly expressed in leaves or flowers, and their expression levels varied greatly from the seedling to flower bud differentiation stage. Arabidopsis overexpressing CiNF-YC1 and CiNF-YC3 showed significantly delayed flowering, accompanied by other morphological alterations. RT-qPCR analysis revealed that genes associated with photoperiod, vernalization, aging, and gibberellin pathways were downregulated in CiNF-YC1-OX lines, relative to the wild type, whereas in CiNF-YC3-OX lines, only SHORT VEGETATIVE PHASE (AtSVP), the key factor in the ambient temperature pathway, was upregulated. Taken together, these findings suggest that CiNF-YC1 and CiNF-YC3 negatively regulate flowering in Arabidopsis via different flowering pathways.

Phase I clinical trial of a novel autologous modified-DC vaccine in patients with resected NSCLC.

BACKGROUND: The primary aim of this study was to evaluate the safety of a novel dendritic cell (DC) vaccine pulsed with survivin and MUC1, silenced with suppressor of cytokine signaling 1 (SOCS1), and immune stimulated with flagellin for patients with stage I to IIIA non-small cell lung cancer (NSCLC) in a phase I open-label, uncontrolled, and dose-escalation trial. Moreover, we evaluate the potential efficacy of this modified DC vaccine as secondary aim. METHODS: The patients were treated with the vaccine at 1 × 106, 1 × 107and the maximum dose 8 × 107 at day 7, 14, and 21 after characterization of the vaccine phenotype by flow cytometry. The safety of the vaccine was assessed by adverse events, and the efficacy by the levels of several specific tumor markers and the patient quality of life. RESULTS: The vaccine was well tolerated without dose-limiting toxicity even at higher doses. The most common adverse event reported was just grade 1 flu-like symptoms without unanticipated or serious adverse event. A significant decrease in CD3 + CD4 + CD25 + Foxp3+ T regulatory (Treg) cell number and increase in TNF-α and IL-6 were observed in two patients. Two patients showed 15% and 64% decrease in carcino-embryonic antigen and CYFRA21, respectively. The vaccination with the maximum dose significantly improved the patients'quality of life when administered at the highest dose. More importantly, in the long-term follow-up until February 17, 2017, 1 patient had no recurrence, 1 patients had a progressive disease (PD), and 1 patient was died in the low dose group. In the middle dose group, all 3 patients had no recurrence. In the high dose group, 1 patient was died, 1 patient had a PD, and the other 7 patients had no recurrence. CONCLUSIONS: We provide preliminary data on the safety and efficacy profile of a novel vaccine against non-small cell lung cancer, which was reasonably well tolerated, induced modest antitumor activity without dose-limiting toxicity, and improved patients' quality of life. Further more, the vaccine maybe a very efficacious treatment for patients with resected NSCLC to prevent recurrence. Our findings on the safety and efficacy of the vaccine in this phase I trial warrant future phase II/III clinical trial.

[Biological roles of somatostatin in intestinal macaque Peyer's patch B cells].

OBJECTIVE: To explore the effects of somatostatin (SST) on macaque intestinal Peyer's patches (PP) in immune B cells and explore its mechanism. METHODS: A total of 15 healthy adult macaques were randomized into control,MODS and MODS+SST groups.Surgical procedures of MODS in macaques: For MODS group, anesthesia was maintained with diazepam (0.16 ± 0.09) mg×kg(-1)×h(-1), i.v.). A catheter was inserted into a peripheral vein for infusing 0.9% saline and 20 g glucose (0.1-0.2 ml×kg(-1)×min(-1), i.v.gtt) for 24 h. Midline laparotomy was performed. Then superior mesenteric artery (SMA) was isolated and occluded with a microsurgical clip. After a 1-hour occlusion, clip was removed and intestinal perfusion reestablished.In MODS+SST group, SST was infused intravenously with a syringe pump at a dosage of 5 µg×kg(-1)×h(-1) for 5 min before an occlusion of SMA until the end of experiment.Venous blood samples were redrawn and the animals sacrificed at 24 h post-IIR for harvesting vital organs. The changes of organs and the morphological changes of PP were detected by hematoxylin and eosin. And the expressions of TLR4, TLR2, CD20, CD5, α4ß7 and MadCAM-1 were evaluated by immunohistochemical staining.Semiquantitative immunohistochemical analysis of raw data was performed with Image Pro Plus 4.0 software. RESULTS: All animals in MODS group presented with small intestines PP increased both in number and size compared with control group (4.8 ± 2.3 vs 1.2 ± 0.9, P < 0.05). After prophylactic to SST, compared with MODS group, the number of PP in small intestines in MODS+SST group decreased (2.7 ± 1.5 vs 4.8 ± 2.3, P < 0.05), but there was no significant difference in morphological of PP. The expression of CD20(+) of B-cells in MODS group was significantly lower than in normal group (integrated optical density (IOD), 64.22 ± 42.45 vs 100.00 ± 86.67, P < 0.05).Interestingly, after prophylactic dosing of SST, the expression level of CD20(+) of B-cells elevated significantly in MODS+SST group compared with that in MODS group (129.02 ± 75.04 vs 64.22 ± 42.45, P < 0.05). There was no α4ß7 expression of B-cells in PP of macaques in three groups. And the expression level of MadCAM-1 was strongly up-regulated after prophylactic dosing of STT compared with MODS. After prophylactic dosing of STT, the expressions of TLR4 and TLR2 declined significantly compared with MODS (56.60 ± 6.83 vs 93.26 ± 10.40, 35.56 ± 4.71 vs 62.06 ± 9.90, P < 0.05). Plasma cells within normal intestinal mucosa were predominantly located in lamina propria. During MODS, plasma cells almost disappeared. After prophylactic dosing of STT, compared to MODS group, there was a rebound of plasma cells. CONCLUSIONS: Endogenous SST controls the switch of B-cells in PP between natural and acquired immunities. The prophylactic dosing of SST could convert excessive natural immunity into beneficial acquired humoral immunity. And SST may facilitate the prevention of multiple organ dysfunction syndromes.

Association of CXCR1 and 2 expressions with gastric cancer metastasis in ex vivo and tumor cell invasion in vitro.

BACKGROUND: CXCR1 and CXCR2, cell surface receptors of interleukin-8, regulate cell migration and alteration of their expression has been associated with poor prognosis of various cancers. The aim of this study was to detect their expression in gastric cancer to identify associations with another cell adhesion molecule, matrix metalloproteinase-9 (MMP9), and with clinicopathological data ex vivo, and then explore their potential role in gastric cancer cells in vitro. MATERIALS AND METHODS: A total of 172 cases of gastric cancer tissue specimens were collected for immunohistochemical analysis of CXCR1, CXCR2, and MMP9 expression. Expression of CXCR1 and CXCR2 proteins was knocked in or down using their cDNA and shRNA, respectively, in gastric cancer cell lines to assess the changed cell phenotypes and gene expression. RESULTS: CXCR1, CXCR2, and MMP9 were expressed in 61.0%, 77.9%, and 75.6% of gastric cancer tissues, respectively. Moreover, CXCR1 and CXCR2 expression was associated with tumor differentiations, advanced clinical stages, lymph node, and distant metastasis of gastric cancer. Similarly, MMP9 expression was associated with CXCR1 and CXCR2. Expression of these three proteins was interrelated. In vitro study showed that levels of CXCR1 and CXCR2 proteins were associated with the capacity of gastric cancer cell migration, while knockdown of their expression inhibited gastric cancer cell migration and invasion abilities in vitro. In contrast, overexpression of CXCR1 and CXCR2 proteins promoted tumor cell migration and invasion. At the gene levels, knockdown of CXCR1 or CXCR2 expression suppressed expression of Ets-1, SRC-1, and JNK proteins and phosphorylated c-Jun and Erk1/2. Conversely, upregulation of CXCR1 or CXCR2 promoted expression of Ets-1, SRC-1, JNK, and c-Jun proteins and phosphorylated JNK, c-Jun and Erk1/2. CONCLUSIONS: These findings suggest that CXCR1 and CXCR2 play an important role in gastric cancer progression. Further study will be performed to investigate whether target of their expression can be used as a novel strategy in clinical control of gastric cancer metastasis.

Somatostatin inhibits the production of interferon-γ by intestinal epithelial cells during intestinal ischemia-reperfusion in macaques.

BACKGROUND: Our previous study found that somatostatin (SST) inhibited the intestinal inflammatory injury in a macaque model of intestinal ischemia-reperfusion (IIR); however, the underlying mechanism was unclear. AIMS: The present study was aimed to investigate the effects of SST on IFN-γ and the systemic inflammatory response after IIR. METHODS: Fifteen macaques were randomly divided into controls, IIR and SST+ IIR groups. ELISA was performed to measure IFN-γ in ileum tissues, ileac epithelial cells (IECs) and ileal lymphocytes, as well as the systemic levels of IL-6, IL-1ß, TNF-α and IFN-γ in the peripheral circulation and the portal vein. HE staining was performed to evaluate morphological changes in vital organs. Immunohistochemistry was performed to identify the distribution of IFN-γ, CD4, CD8 and CD57 in the ileum. RESULTS: After IIR, IFN-γ level was significantly increased in the IECs. IL-6, IL-1ß and TNF-α were significantly increased in both the portal vein and the peripheral circulation; in contrast, IFN-γ level was increased in the portal vein alone. Prophylactic SST reversed the change in IFN-γ in the IECs and portal vein. SST led to an alleviation of the pathological changes in systemic vital organs. The distribution of CD4(+), CD57(+) and CD8(+) cells was not positively correlated with the secretion of IFN-γ. CONCLUSION: IECs are the main source of IFN-γ production after IIR. SST may indirectly lead to mast cell deactivation through the inhibition of IFN-γ production by IECs. Pretreatment with SST may be beneficial for preventing a massive systemic inflammatory response in vital organs after IIR.

cis-Tri-aqua-[1,1'-(propane-1,3-di-yl)bis-(pyridin-1-ium-4-carboxyl-ato)-κO]bis-(thio-cyanato-κN)manganese(II) dihydrate.

In the title compound, [Mn(NCS)2(C15H14N2O4)(H2O)3]·2H2O, the metal ion is octa-hedrally coordinated by three water mol-ecules, one carboxyl-ate O atom from a 1,1'-(propane-1,3-di-yl)bis-(pyridinium-4-carboxyl-ate) ligand and two N atoms from two thio-cyanate anions in cis positions, forming a mononuclear complex mol-ecule. In the crystal, mol-ecules are connected into a three-dimensional architecture through O-H⋯O hydrogen bonds involving water mol-ecules and carboxyl-ate groups.

Comprehensive Analyses of Four PhNF-YC Genes from Petunia hybrida and Impacts on Flowering Time.

Nuclear Factor Y (NF-Y) is a class of heterotrimeric transcription factors composed of three subunits: NF-A, NF-YB, and NF-YC. NF-YC family members play crucial roles in various developmental processes, particularly in the regulation of flowering time. However, their functions in petunia remain poorly understood. In this study, we isolated four PhNF-YC genes from petunia and confirmed their subcellular localization in both the nucleus and cytoplasm. We analyzed the transcript abundance of all four PhNF-YC genes and found that PhNF-YC2 and PhNF-YC4 were highly expressed in apical buds and leaves, with their transcript levels decreasing before flower bud differentiation. Silencing PhNF-YC2 using VIGS resulted in a delayed flowering time and reduced chlorophyll content, while PhNF-YC4-silenced plants only exhibited a delayed flowering time. Furthermore, we detected the transcript abundance of flowering-related genes involved in different signaling pathways and found that PhCO, PhGI, PhFBP21, PhGA20ox4, and PhSPL9b were regulated by both PhNF-YC2 and PhNF-YC4. Additionally, the transcript abundance of PhSPL2, PhSPL3, and PhSPL4 increased only in PhNF-YC2-silenced plants. Overall, these results provide evidence that PhNF-YC2 and PhNF-YC4 negatively regulate flowering time in petunia by modulating a series of flowering-related genes.

Computational comparison of anterior lumbar interbody fusion and oblique lumbar interbody fusion with various supplementary fixation systems: a finite element analysis.

BACKGROUND AND OBJECTIVE: Anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF) have shown a great surgical potential, while it has always been controversial which surgical approach and which type of fixation system should be selected. This study investigated the biomechanical response of ALIF and OLIF with various supplementary fixation systems using the finite element method. MATERIALS AND METHODS: Lumbar L4-L5 ALIF and OLIF models stabilized by different supplementary fixation systems (stand-alone cage, integrated stand-alone cage, anterior plate, and bilateral pedicle screw) were developed to assess the segmental range of motion (ROM), endplate stress (EPS), and screw-bone interface stress (SBIS). EXPERIMENTAL RESULTS: ALIF showed lower ROM and EPS than OLIF in all motion planes and less SBIS in the most of motion planes compared with OLIF when the anterior plate or pedicle screw was used. ALIF induced higher ROM, while lower EPS and SBIS than OLIF in the majority of motion planes when integrated stand-alone cage was utilized. Using a stand-alone cage in ALIF and OLIF led to cage migration. Integrated stand-alone cage prevented the cage migration, whereas caused significantly larger ROM, EPS, and SBIS than other fixation systems except for the rotation plane. In the most of motion planes, the pedicle screw had the lowest ROM, EPS, and SBIS. The anterior plate induced a slightly larger ROM, EPS, and SBIS than the pedicle screw, while the differences were not significant. CONCLUSION: ALIF exhibited a better performance in postoperative segmental stability, endplate stress, and screw-bone interface stress than OLIF when the anterior plate or the pedicle screw was used. The pedicle screw could provide the greatest postoperative segmental stability, less cage subsidence incidence, and lower risk of fixation system loosening in ALIF and OLIF. The anterior plate could also contribute to the stability required and fewer complications, while not as effectively as the pedicle screw. Extreme caution should be regarded when the stand-alone cage is used due to the risk of cage migration. The integrated stand-alone cage may be an alternative method; however, further optimization is needed to reduce complications and improve postoperative segmental stability.

Biocompatibility and osteointegration capability of ß-TCP manufactured by stereolithography 3D printing: In vitro study.

Beta-tricalcium phosphate (ß-TCP) bioceramics have an inorganic composition similar to the human bone. While conventional methods can only produce ceramic scaffolds with poor controllability, the advancement of 3D-printing, especially stereolithography, made it possible to manufacture controllable, highly precise, micropore ceramic scaffolds. In this study, the stereolithography was applied to produce ß-TCP bioceramics, while ZrO2, Al2O3, Ti6Al4V, and polyetheretherketone (PEEK) were used as controls. Phase analysis, water contact angle tests, and Micro-CT were applied to evaluate the surface properties and scaffold. Hemolytic toxicity, cell proliferation, and morphological assessment were performed to evaluate the biocompatibility. Alkaline phosphatase (ALP) level, mineralization, and qRT-PCR were measured to evaluate the osteointegration. During the manufacturing of ß-TCP, no evident impurity substance and hemolytic toxicity was found. Cells on ß-TCP had good morphologies, and their proliferation capability was similar to Ti6Al4V, which was higher than the other materials. Cells on ß-TCP had higher ALP levels than PEEK. The degree of mineralization was significantly higher on ß-TCP. The expression of osteogenesis-related genes on ß-TCP was similar to Ti6Al4V and higher than the other materials. In this study, the ß-TCP produced by stereolithography had no toxicity, high accuracy, and excellent osteointegration capability, thus resulting as a good choice for bone implants.

Relationship between homologous recombination deficiency and clinical features of breast cancer based on genomic scar score.

BACKGROUND: Homologous recombination deficiency (HRD) phenotype will sensitize tumors to poly (ADP-ribose) polymerases inhibitors and platinum. However, previous studies did not focus on the prevalence of HRD among Chinese breast cancer (BC) patients. METHODS: One hundred and forty-seven BC patients were included in this study. Their HRD status was assessed by Genomic Scar Score (GSS), which was determined according to the length, site, and type of copy number. HRD was defined as positive when a harmful BRCA1/2 mutation was detected or GSS ≥50. RESULTS: Our data revealed that 9.5% of the 147 patients tested positive for BRCA1/2 mutation, while approximately 34.7% were HRD-positive. For triple negative BC (TNBC), HRD positivity rate (60.5%) was higher than Luminal A (5.3%), Luminal B (HER2-) (28.8%), and Luminal B (HER2+) (31.6%) subgroups. HRD-positive tumors were more likely to be ER/PR-negative and exhibited higher Ki-67 expression. 50.0% of the HRD-positive patients achieved pathologic complete remission (pCR) after neoadjuvant therapy. HRD-positive patients tended to have a higher risk for cancer recurrence or metastasis compared to HRD-negative patients (29.4% vs. 13.5%). CONCLUSION: We investigated the HRD status among Chinese BC patients using an HRD detection tool developed based on the Chinese population. The clinical characteristics, pathological profile, family history pattern, neoadjuvant efficacy, and disease progression events of HRD-positive and negative patients were described and compared. Thus, our data provided an evidence-based basis for applying the original HRD assay in Chinese BC.

Gut microbiota therapy for nonalcoholic fatty liver disease: Evidence from randomized clinical trials.

Nonalcoholic fatty liver disease (NAFLD) has a high prevalence worldwide, but there are no medications approved for treatment. Gut microbiota would be a novel and promising therapeutic target based on the concept of the gut-liver axis in liver disease. We reviewed randomized controlled trials on gut microbiota therapy in NAFLD in this study to evaluate its efficacy and plausibility in NAFLD.

Shortened key growth periods of soybean observed in China under climate change.

Phenology is an important indicator of global climate change. Revealing the spatiotemporal characteristics of crop phenology is vital for ameliorating the adverse effects of climate change and guiding regional agricultural production. This study evaluated the spatiotemporal variability of soybean's phenological stages and key growth periods, and assessed their sensitivity to key climatic factors, utilizing a long-term dataset (1992-2018) of soybean phenology and associated meteorological data collected at 51 stations across China. The results showed that (1) during the soybean growing seasons from 1992 to 2018, the average temperature (0.34 ± 0.09 â„ƒ decade-1) and cumulative precipitation (6.66 ± 0.93 mm decade-1) increased, but cumulative sunshine hours (- 33.98 ± 1.05 h decade-1) decreased. (2) On a national scale, dates of sowing, emergence, trifoliate, anthesis, and podding of soybean were delayed, while the maturity date showed an advancing trend. The vegetative growth period (- 0.52 ± 0.24 days decade-1) and whole growth period (- 1.32 ± 0.30 days decade-1) of soybean were shortened, but the reproductive growth period (0.05 ± 0.26 days decade-1) was slightly extended. Trends in soybean phenological stages and key growth periods diverged in regions. Soybean phenological stages were delayed in Huang-Huai-Hai soybean zone, whereas advanced in southern soybean zone. Moreover, the key growth periods were greatly shortened in northern soybean zone. (3) In general, the sensitivity of soybean key growth periods to temperature was negative, whereas those to precipitation and sunshine hours differed among regions. In particular, most phenological stages were negatively sensitive to sunshine hours. Our results will provide scientific support for decision-making in agricultural production practices.

The effect of intravenous infusion on the rapid recovery of elderly patients treated with painless colonoscopy and the value of ultrasonic measurement of the inferior vena cava diameter in guiding intravenous infusion.

BACKGROUND: Elderly patients with painless colonoscopy often complain listlessness, fatigue when they left postanesthesia care unit (PACU). These patients also commonly occur hypotension during anesthesia. However, intravenous infusion and blood volume assessment are seldom performed in elderly patients. Therefore, we aimed to observe the effect of intravenous infusion and to explore the value of inferior vena cava diameter (IVCD) measurement by ultrasound in rapid recovery. METHODS: Randomized, controlled, clinical trials, elderly patients (aged ≥60 years) with painless colonoscopy were randomly divided into two groups: intravenous infusion versus no intravenous infusion was administered procedure. The primary outcome observed was the time required for complete recovery from anesthesia. Secondary outcomes included willingness to accept follow-up colonoscopy, discomfort symptoms, changes in the inferior vena cava (IVC)-related parameters. Hypotension was defined as a ≥20% decrease in systolic blood pressure (SBP) from baseline. The patients in the two groups were divided into non-hypotensive and hypotensive subgroups, respectively. Receiver operating characteristic (ROC) curves were used to determine the efficacy of the IVC-related parameters for predicting hypotension and the optimal threshold. RESULTS: A total of 65 patients were enrolled, including 34 patients in the infusion group and 31 patients in the conventional group. Administration of intravenous infusion reduced the time required for complete recovery and increased the willingness to accept follow-up colonoscopy and reduced discomfort symptoms. The IVC-related parameters were changed before and after bowel preparation and after reaching infusion loading dose. The ROC curve was used to predict hypotension during anesthesia. The maximum value of inferior vena cava diameter (IVCDmax) was the best predictive efficacy in the both groups [area under the ROC curve (AUC) =0.839, AUC =0.877, respectively]. CONCLUSIONS: Intravenous infusion promotes the rapid recovery of elderly patients with painless colonoscopy. Measurement of the IVCDmax can help to guide intravenous infusion.

Electroclinical and Multimodality Neuroimaging Characteristics and Predictors of Post-Surgical Outcome in Focal Cortical Dysplasia Type IIIa.

Focal cortical dysplasia (FCD) type IIIa is an easily ignored cause of intractable temporal lobe epilepsy. This study aimed to analyze the clinical, electrophysiological, and imaging characteristics in FCD type IIIa and to search for predictors associated with postoperative outcome in order to identify potential candidates for epilepsy surgery. We performed a retrospective review including sixty-six patients with FCD type IIIa who underwent resection for drug-resistant epilepsy. We evaluated the clinical, electrophysiological, and neuroimaging features for potential association with seizure outcome. Univariate and multivariate analyses were conducted to explore their predictive role on the seizure outcome. We demonstrated that thirty-nine (59.1%) patients had seizure freedom outcomes (Engel class Ia) with a median postsurgical follow-up lasting 29.5 months. By univariate analysis, duration of epilepsy (less than 12 years) (p = 0.044), absence of contralateral insular lobe hypometabolism on PET/MRI (p Log-rank = 0.025), and complete resection of epileptogenic area (p Log-rank = 0.004) were associated with seizure outcome. The incomplete resection of the epileptogenic area (hazard ratio = 2.977, 95% CI 1.218-7.277, p = 0.017) was the only independent predictor for seizure recurrence after surgery by multivariate analysis. The results of past history, semiology, electrophysiological, and MRI were not associated with seizure outcomes. Carefully included patients with FCD type IIIa through a comprehensive evaluation of their clinical, electrophysiological, and neuroimaging characteristics can be good candidates for resection. Several preoperative factors appear to be predictive of the postoperative outcome and may help in optimizing the selection of ideal candidates to benefit from epilepsy surgery.

New anti-reflux plastic stent to reduce the risk of stent-related cholangitis in the treatment of biliary strictures.

BACKGROUND: There is little data available on the role of new anti-reflux plastic stents (ARPSs). AIM: To compare the use of ARPSs with that of traditional plastic stents (TPSs) for patients with biliary strictures. METHODS: Consecutive patients with biliary strictures who underwent first endoscopic biliary stenting between February 2016 and May 2019 were included. The onset of stent-related cholangitis, stent patency, clinical success, and other adverse events were evaluated. RESULTS: Sixty-seven patients in the ARPS group and 66 patients in the TPS group were included in the final analyses. Fewer patients experienced stent-related cholangitis in the ARPS group than that in the TPS group (8 patients vs 18 patients; P = 0.030). The median time till the onset of first stent-related cholangitis was later in the ARPS group than that in the TPS group (128.5 d vs 76 d; P = 0.039). The cumulative median stent patency in the ARPS group was 185 d, which was significantly longer than that in the TPS group (133 d; P = 0.001). The clinical success rates and other adverse events did not significantly differ between both groups. CONCLUSION: Placement of new ARPS might be a safe and effective optional therapeutic strategy to reduce the risk of stent-related cholangitis and prolong stent patency.

Prophylactic transcatheter angiographic embolization reduces Forrest IIa ulcer rebleeding: A retrospective study.

ABSTRACT: The application of transcatheter angiographic embolization (TAE) is controversial in the treatment of ulcer bleeding. This study aims to determine rebleeding risk factors and evaluate the efficacy of prophylactic TAE (p-TAE) following endoscopic hemostasis in rebleeding prevention of Forrest lla ulcers.The medical records of Forrest lla ulcer patients who underwent endoscopic hemostasis (E group) and endoscopic hemostasis plus p-TAE (E + p-TAE group) in West China Hospital from May 2009 to May 2018 were retrospectively reviewed. Baseline characteristics, clinical efficacy, and rebleeding risk factors were analyzed.As a result, a total of 102 patients were included, with 75 and 27 patients in E and E + p-TAE group, respectively. Most of the baseline data in E and E + p-TAE group were similar except for the proportion of protruded non-bleeding visible vessel (NBVV) (E group vs E + p-TAE group, 50.7% vs 74.1%, P = .035). The rebleeding rate of E + p-TAE group (3.7%) was significantly lower than E group (24.0%) (P = .02). The protruded NBVV (OR: 6.896, 95% confidence interval [CI]: 1.532-30.642, P = .01) and employment of p-TAE (OR: 0.038, 95% CI: 0.003-0.448, P = .009) were identified as independent risk factors for Forrest IIa ulcer rebleeding. Additionally, log-rank test indicated the rebleeding occurrence was greatly reduced by p-TAE in patients with protruded NBVVs (P = .006).In conclusion, the protruded NBVV and employment of p-TAE were the independent risk factors tightly associated with rebleeding of Forrest IIa ulcer. P-TAE following endoscopic hemostasis could effectively prevent Forrest IIa ulcer from rebleeding.