Pathogenesis and management of superficial venous aneurysms through a case of thrombosed large great saphenous vein aneurysm.

INTRODUCTION: Superficial venous aneurysms are uncommon entities though venous Doppler has facilitated the detection of asymptomatic small aneurysms. Thromboembolic complications are rare with superficial venous aneurysms. The data regarding optimal therapy and pathogenesis of superficial venous aneurysm is sparse and is limited to isolated case reports. METHODS: Here, we present an unusual case of thrombosed large great saphenous vein aneurysm which was managed with Doppler, preoperative anticoagulation and surgical excision. RESULTS AND CONCLUSION: This paper is intended to review the current knowledge about the pathogenesis of superficial venous aneurysm of lower extremities, their optimal management and to guide future research in this area.

Incisions for Parotidectomy: A Narrative Review.

ABSTRACT: In the last 2 decades, authors have gained considerable interest in modifying the age-old classical parotidectomy incisions to address cosmetic concerns of their patients. The article reviews all the incisions that have been introduced over time after modified facelift and Blair incision for performing parotidectomy. These include retroauricular hairline approach, Arden technique, trichophytic incision, periauricular incision, intraauricular modification of facelift approach, endaural approach, postaural approach, Panda technique, preauricular crutch approach, and mini Blair incision. Although these have been reported to be safe, feasible, and cosmetically better approaches, at present, the absence of well-designed prospective observational and interventional studies do not warrant them to be widely used in clinical practice. This will guide surgeons in making patient curated parotidectomy incisions under special circumstances. Currently, these remain limited to the hands of experienced surgeons in high volume centers.

Visual abstracts do not increase some impact scores more than conventional abstracts of clinical research: A retrospective cohort study.

BACKGROUND AND OBJECTIVE: We examined whether the use of visual abstracts on social media platforms can improve comprehensive social media and conventional metrics such as total altmetric attention score, full text page views and citation counts (study outcomes) through retrospective cohort study. METHODS: We included all original research articles (Total 307 articles: N = 69 in visual abstract group and N = 238 in control group) published between July 2018 and January 2019 in the JAMA, BMJ and the NEJM and used negative binomial regression to adjust for article characteristics. RESULTS: Adjusted analysis showed no significant differences between articles with and without visual abstracts in the altmetric attention score (p = 0.37) and in number of page views (p = 0.44). Citations in the Web of Science core collection were found to be statistically significant favouring control group (p = 0.028). We also found no significant differences in altmetric attention score and page views after stratification for article type [randomised controlled trial (RCT) vs. non-RCT]. Citations counts were found to be borderline significant for RCT (p = 0.04) and non-significant for non-RCT. CONCLUSION: Visual abstracts might not be effective in disseminating scientific research. We should look at other innovative ways to improve the visibility of the research.

Synthesis of lantadene analogs with marked in vitro inhibition of lung adenocarcinoma and TNF-α induced nuclear factor-kappa B (NF-κB) activation.

The new series of pentacyclic triterpenoids reduced lantadene A (3), B (4), and 22ß-hydroxy-3-oxo-olean-12-en-28-oic acid (5) analogs were synthesized and tested in vitro for their NF-κB and IKKß inhibitory potencies and cytotoxicity against A549 lung cancer cells. The lead analog (11) showed sub-micromolar activity against TNF-α induced activation of NF-κB and exhibited inhibition of IKKß in a single-digit micromolar dose. At the same time, 11 showed promising cytotoxicity against A549 lung cancer cells with IC50 of 0.98 µM. The Western blot analysis further showed that the suppression of NF-κB activity by the lead analog 11 was due to the inhibition of IκBα degradation, a natural inhibitor of NF-κB. The physicochemical evaluation demonstrated that the lead analog 11 was stable in the simulated gastric fluid of pH 2, while hydrolyzed at a relatively higher rate in the human blood plasma to release the active parent moieties. Molecular docking analysis showed that 11 was hydrogen bonded with the Arg-31 and Gln-110 residues of the IKKß.

Quality of Life in Patients Undergoing Endoscopic Thyroidectomy Versus Conventional Open Thyroidectomy: Interim Results From Randomized Trial.

OBJECTIVE: We determined whether endoscopic thyroidectomy (ET) is associated with better health-related quality of life (QoL) compared with open thyroidectomy. METHODS: We randomly assigned 28 patients aged older than 18 years, Bethesda IV or less on cytology and gland volume of <40 mL to undergo hemithyroidectomy through either open or endoscopic (axillo-breast approach/bilateral axillo-breast approach) technique. The primary outcome was QoL scores on the Short Form-36 and Thyroid-Specific Questionnaire at 2, 6, and 12 weeks postsurgery. Secondary outcomes were postoperative complications, hospital stay, and pain scores. RESULTS: The generic QoL scores based on Short Form-36 were statistically nonsignificant between the two groups. QoL scores based on Thyroid-Specific Questionnaire were statistically significant (P < 0.05) favoring open thyroidectomy in the following domains: (1) numbness at 2, 6, and 12 weeks (P = 0.04, 0.004, and 0.005, respectively), (2) shoulder impairment at 2 weeks (P = 0.017), and (3) favoring ET in cosmesis at 6 and 12 weeks (P = 0.037 and 0.02, respectively). ET has longer operative time (104.6 ± 25.4 vs 123 ± 8.9 min; P = 0.03), longer hospital stays (2.8 ± 0.4 vs 2.4 ± 0.5; P = 0.056) and higher pain scores at 2 and 6 weeks (P = 0.007 and 0.012, respectively) but decreased intraoperative bleeding (33.5 ± 6.4 vs 29.1 ± 3.7 mL; P = 0.037). CONCLUSION: ET has higher cosmetic satisfaction, increased numbness, and shoulder movement impairment during short-term postsurgery follow-up. Both techniques are similar in impacting general physical, mental, and social health-related QoL. (Clinical Trials Registry of India, Reg. No. CTRI/2020/07/026374).

Author self-citations in the urology literature.

Objective: We aimed to determine the diachronous self-citation rate and the various article characteristics which can influence the rate and percentage of diachronous author self-citations using papers published in high-rank urology journals. Methods: We included all papers (N = 327 articles) published between January 2015 to April 2015 in the European Urology, The Journal of Urology and the BJU International. We determined author self-citations using the Scopus database and used negative binomial regression to determine which article characteristics affect self-citations. Results: 262 articles (80.2%) contained at least one self-citation.The mean number and percentage of author self-citations were 6.5 and 14.2 respectively. Adjusted analysis showed that the experimental/animal study design and the number of authors were significantly associated with both the number (IRR = 2.12, P = 0.011; IRR = 1.03, P = 0.002) and percentage of author self-citations (IRR = 2.95, P = 0.003; IRR = 1.03, P = 0.012). The number of citations in the Scopus and publication in European Urology were significantly associated with only the number of author self-citations. Conclusion: Diachronous author self-citation rate in urology is higher compared to general medical literature but similar to other surgical subspecialties. It may depend on the study design and the number of authors in the paper. For a more comprehensive evaluation, future studies should look at the context in which self-citations were made.

Citation classics: the 50 most cited articles in surgery in Asia.

Objectives: The term 'citation classics' is used for highly cited papers in the scientific literature. It was aimed to understand the current landscape of academic surgery and the quality of the scientific contribution of authors belonging to Asia using citation classics. Material and Methods: We searched the WoS core collection database under the category 'surgery' to include the 50 most cited articles whose lead author was affiliated to an Asian country during the research period. We noted the following characteristics for each article: total citations, average cita- tions per year, year of publication, publishing journal, institution and country, journal quartile and impact factor, authorship, field of surgical research. Results were analyzed using IBM SPSS Statistics v26. Results: The number of citations ranged from 447 to 1170 (mean +/- SD is 616.9 +/- 150.16) and citations per year ranged from 10.04 to 98.17 (mean +/- SD is 30.87 +/- 17.27). Most productive decade was 1991-2000 (n= 19 articles). Majority of the articles were published in 'Annals of Surgery' (28%). Four authors contributed two or more articles as lead author with 'Poon RTP' taking the lead. Japan's contribution was highest (60%) followed by China and its dependents' (26%). University of Hong Kong was the leading institution (n= 7). Observational study was the most commonly used design (n= 24). Most papers belonged to gastrointestinal surgery (n= 28) and surgical oncology (n= 26). 66% articles originated from a single institution, 22% had inter-institutional collaboration and 12% had national collaboration from countries outside Asia. Conclusion: The study identified the most influential papers in surgery from Asia. This should provoke interest in academic surgery and research col- laboration with other nations in Asia and the rest of the world.

Management of post-traumatic ischaemic ileal stricture using intraoperative indocyanine green fluorescence-guided resection.

Blunt abdominal trauma can affect mesenteric circulation which may lead to bowel strictures. Indocyanine green (ICG) angiography can be used to assess mesenteric blood flow and bowel perfusion as a guide to resect length intraoperatively. But this concept has not been applied to ischaemic bowel strictures. We present a case of ischaemic ileal stricture induced by blunt abdominal trauma which was managed by resection and anastomosis. Intraoperative near-infrared (NIR) ICG angiography was used as a guide to resect the bowel length. This case emphasises that ischaemic bowel strictures should be suspected in patients presenting with intestinal obstruction following trauma. Resection and anastomosis of the affected segment remains the primary treatment modality with excellent outcomes. NIR ICG angiography is a real-time objective and useful resource for assessing bowel perfusion and could be used to determine the length of the segment to be resected in patients with ischaemic bowel stricture.

Topical (+)-catechin emulsified gel prevents DMBA/TPA-induced squamous cell carcinoma of the skin by modulating antioxidants and inflammatory biomarkers in BALB/c mice.

An emulsified gel of (+)-catechin was developed and evaluated topically against 7,12-dimethylbenz(a)anthracene-induced and 12-O-tetradecanoylphorbol-13-acetate-promoted (DMBA-induced and TPA-promoted) squamous cell carcinoma of the skin in BALB/c mice. The biological evaluation outcome indicated that the (+)-catechin emulsified gel increased the activity of oxidative stress biomarkers glutathione (GSH), superoxide dismutase (SOD), catalase (CAT), glutathione S-transferase (GST), glutathione reductase (GR), and glutathione peroxidase (GPx), whereas it decreased the level of malondialdehyde (MDA). The mechanistic study showed that genes implicated in the inflammation and cancer, such as cyclooxygenase-2 (COX-2), nuclear factor-kappa B (NF-κB), and inducible nitric-oxide synthase (iNOS), were down-regulated by (+)-catechin emulsified gel while inhibiting an inflammatory mediator prostaglandin E2 (PGE2). The (+)-catechin emulsified gel further suppressed the activity of pro-inflammatory cytokines, viz. tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß), and interleukin-6 (IL-6). The in vitro permeation study revealed that release of (+)-catechin from an emulsified gel base reached a steady state after 6 h, while pH of the entire emulsified gel was found to be between 6.2 and 6.5 that falls well within the normal pH range of the skin.