Sandwich excision in patients with placenta percreta involving maternal bladder.

OBJECTIVE: Our aim is to describe and assess a Sandwich Excision (placenta-uterine-bladder excision together) surgical technique for women with clinically confirmed placenta percreta involving the maternal bladder. PATIENTS AND METHODS: A retrospective cohort study was performed on all patients with clinically confirmed placenta percreta involving the maternal bladder who underwent Sandwich Excision at our large academic institution from January 1, 2014, to June 30, 2019. RESULTS: Twenty-three patients were included. Four patients underwent hysterectomy, and one patient underwent subhysterectomy. The mean duration of surgery was 228.04 ± 85.59 minutes (range, 90.00-503.00 minutes). The mean estimated blood loss was 5,269.57 ± 2,745.81 mL (range, 1,000.00-12,500.00 mL). No thromboembolic events occurred, and there were no maternal or neonatal deaths among the subjects in this study. CONCLUSIONS: Sandwich excision is associated with a low rate of hysterectomy in women with placenta percreta involving the maternal bladder. The procedure is a relatively safe technique and can be performed safely by experienced obstetricians who are familiar with the uterus-bladder space. Meanwhile, the success rates and complications of the Sandwich Excision in these patients also need to be evaluated in prospective studies.

Alamandine protects rat from myocardial ischemia-reperfusion injury by activating JNK and inhibiting NF-κB.

OBJECTIVE: The aim of this study was to investigate whether alamandine plays a protective role in myocardial ischemia-reperfusion injury (IRI) by activating C-Jun N-terminal kinase (JNK) and inhibiting the expression of key proteins in nuclear factor-kappa B (NF-κB) pathway. MATERIALS AND METHODS: Twenty-four Sprague Dawley (SD) rats were numbered and divided into three groups using a random number table, including sham operation group (Sham group), myocardial ischemia-reperfusion injury model group (IRI group), and alamandine pretreatment and myocardial IRI treatment (alamandine group), with 8 SD rats per group. Myocardial tissues were collected from each group. The damage of myocardial tissue was detected using hematoxylin-eosin (H&E) and Masson staining. Finally, the expression levels of JNK and NF-κB pathway-related proteins in myocardial tissue of each group were detected by Western blot. RESULTS: Compared with the IRI group, the alamandine treatment significantly improved cardiac function indicators induced by myocardial IRI in rats, including HR, MAP, LVESP, LVEDP, LVdp/dtmax, and -LVdp/dtmax. In addition, the pathological changes and cell damage of myocardium after alamandine pretreatment were significantly alleviated. At the same time, alamandine can significantly reduce the levels of TNF-α, IL-1ß, IL-6, and NO. Finally, Western blot analysis showed that alamandine pre-treatment can protect cardiomyocytes from myocardial IRI by activating JNK phosphorylation and inhibiting the expression of related proteins in the NF-κB signaling pathway. CONCLUSIONS: Alamandine can protect rat from myocardial IRI via activating JNK phosphorylation and inhibiting NF-κB signaling pathway to reduce the inflammatory response.

Variability in lipid profile among patients presented with acute myocardial infarction, unstable angina and stable angina pectoris.

OBJECTIVE: Despite the amply evidence and guidelines in treating coronary artery disease (CAD) with lipid-lowering therapy, physicians still have concerns in treating acute myocardial infarction (AMI) patients who have the low serum lipid level. We explored the adequacy of lipid-lowering therapy in treating AMI patients. PATIENTS AND METHODS: Over 3000 CAD lipid profile data were collected, their data were divided into 3 groups (AMI; stable angina pectoris (SAP) and unstable angina pectoris (UAP) group) based their clinical characteristics. Statistical analyses were performed to compare their baseline lipid levels and clinical feature. RESULTS: The total cholesterol (TC), low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) level in AMI patients were the lowest, followed by UAP patient group and SAP patient group. There were significant differences in white blood count (WBC) and ejection fraction (EF) between 3 groups. A good correlation was confirmed between EF% and the lipid parameters of TC, LDL-c, HDL-c, non-HDL-c. WBC did not correlate with the lipid except HDL-c. AMI is an acute inflammatory reaction that is accompanied with the change of lipid level. CONCLUSIONS: Although the level of TC, LDL-c and HDL-c are lower in AMI, but it is related with acute inflammatory reaction during the rupture of atherosclerotic plaques. Lipid-lowering therapy should not be delayed in treating AMI patients with lower lipid level.

Secondary diabetes associated with 5-fluorouracil-based chemotherapy regimens in non-diabetic patients with colorectal cancer: results from a single-centre cohort study.

AIM: The aim of the study was to analyse the prevalence and characteristics of secondary diabetes induced by 5-fluorouracil (5-FU) based chemotherapy in non-diabetic patients with colorectal cancer (CRC). METHOD: A total of 422 consecutive CRC patients who received 5-FU-based chemotherapy were retrospectively analysed. Fasting plasma glucose (FPG) levels were determined before each cycle of chemotherapy during active treatment and regular follow-up. The prevalence and characteristics of secondary hyperglycaemia were investigated, with special focus on the clinical outcome. RESULTS: Among the 422 CRC patients, 60 had pre-existing hyperglycaemia. In the remaining 362 with normal FPG levels before chemotherapy, 42 (11.6%) and 41 (11.3%) patients developed diabetes and impaired fasting glucose during the study period. Among the 42 secondary diabetic patients, 22 (52.4%) received anti-diabetes drug therapy, in 7 (16.7%) cases the FPG level returned to normal without any active intervention, and 13 (30.9%) cases received diet control and physiotherapy. Thirty-one (8.6%) patients developed diabetes. Based on the Common Terminology Criteria for Adverse Events, an adverse event over Grade 3 occurred in seven cases during follow-up. Diabetes-related adverse events had a serious negative impact on chemotherapy in six cases. Diabetes-related death occurred in three patients. CONCLUSIONS: Secondary diabetes associated with 5-FU-based chemotherapy occurs in around 10% of CRC patients, with a significant negative impact on treatment and clinical outcome. 5-FU-related diabetes should be regarded as a common side effect of 5-FU treatment.