Clear Clinical Significance Research Articles

Serum Apolipoprotein-A2 Levels Are a Strong Predictor of Future Cardiovascular Events in Patients Undergoing Percutaneous Coronary Intervention.

Because apolipoprotein-A2 (ApoA2), a key component of high-density lipoprotein cholesterol (HDL-C), lacks clear clinical significance, we investigated its impact on cardiovascular events in patients undergoing percutaneous coronary intervention (PCI).Methods and Results: We examined 638 patients who underwent PCI with a new-generation drug-eluting stent for acute or chronic coronary syndrome and had their apolipoprotein levels measured between 2016 and 2021. The patients were divided into 2 groups based on the median serum ApoA2 values, and the incidence of major adverse cardiovascular events (MACE) was assessed. Of the 638 patients, 563 (88%) received statin treatment, with a median serum LDL-C level of 93 mg/dL. Furthermore, 137 patients (21.5%) experienced MACE, and Kaplan-Meier analysis revealed that the higher ApoA2 group had a significantly lower incidence of MACE than the lower ApoA2 group (30.9% vs. 41.6%). However, the other apolipoproteins, including ApoA1, ApoB, ApoC2, ApoC3, and ApoE, showed no significant differences in MACE. Multivariable Cox hazard analysis indicated that ApoA2 was an independent predictor of MACEs (hazard ratio, 0.666; 95% confidence interval, 0.465-0.954). Furthermore, ApoA2 levels exhibited the strongest inverse association with high-sensitivity C-reactive protein levels (rs=-0.479). Among all the apolipoproteins, the serum ApoA2 level may be the strongest predictor of future cardiovascular events and prognosis in patients undergoing PCI.

Influencing factors, surgical management, and predictors of posterior fossa tumors with hydrocephalus in children

Background: Hydrocephalus is a common disease in neurosurgery. In pediatric central nervous system tumors, the proportion of posterior fossa tumors (PFTs) in children is high, hydrocephalus is often the first manifestation, and some cases have de novo or aggravated hydrocephalus after surgery. Objective: To conclude some controversies about the treatment methods and timeline of PFT with hydrocephalus. Methods: This article reviews the latest progress in the literature and practical problems encountered in clinical practices. Results: For most children, surgical drainage is the most effective treatment; however, medical treatment can be performed before surgery or a definite diagnosis is made. In children with PFT, the risk of hydrocephalus can be initially predicted according to the condition of the child, which has clear clinical significance for the selection of treatment methods and the evaluation of related prognosis. Conclusion: PFT is a common site for CNS tumors in children, and its clinical manifestations are often hydrocephalus-related. According to the condition of pediatric patients, early prediction of the risk of hydrocephalus has clear clinical significance for the selection of treatment methods and the evaluation of related prognoses.

Low-Carbohydrate/Ketogenic Diet and Coronary Artery Disease: A Brief Review of the Limited Evidence Between Them.

Nowadays there is a lot of interest among the general population regarding the ketogenic diet (KD) and its health benefits. Most people following this diet have a reduced intake of carbohydrates which gets replaced by calories coming from fat and protein. Even though KD has shown some limited health benefits, there is no consensus on long-term effects and cardiovascular safety profile, especially the relation of KD to coronary artery disease (CAD). This concern comes predominantly from increased fat intake in KD and other similar diets with decreased carbohydrate intake. One study has shown a link between type 1 diabetes and increased coronary artery calcium scores but, in addition to many other limitations, after adjusting for other cardiovascular risk factors, the association was not significant. Results from a subanalysis of the CARDIA prospective study found that progression of CAD measured by coronary artery calcium was more pronounced in people with low-carbohydrate intake, especially when the compensatory calorie intake was from animal sources as compared to plant-based sources. In addition, other studies have tried to find a link between this type of diet and other traditional cardiovascular risk factors that have been traditionally associated with CAD, especially comparing low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride (TAG) levels without clear clinical significance. Other studies found an association between KD and all-cause mortality, but no association with cardiovascular mortality. Lastly, there is an association between animal-based KD and all-cause mortality in patients who have already suffered a myocardial infarction. These findings are modified when accounting for saturated fat intake, which may give us an insight into possible mechanisms to explain these differences.

Effect of 2% Topical Lidocaine Gel on Discomfort from Electrical Stimulation During Nerve Conduction Studies- A Prospective Double-Blind Placebo-Controlled Study.

Procedure discomfort can limit electrodiagnostic studies. Reducing discomfort can maximize the benefits of these diagnostic tools. This study targeted the discomfort associated with nerve conduction studies (NCS). This was a prospective randomized double-blind placebo-controlled study comparing the effect of topical lidocaine gel (2%) versus analgesic-free lubricant gel (K-Y gel) on pain perception during NCS. Sequential patients (n=130) referred for routine NCS participated in the study. We applied 1 mL of lidocaine gel to one palm, and 1 mL of K-Y gel to the other as a control. After 20-45 min of application, graded increments of electrical stimulation intensity were delivered to record the median and ulnar mixed palmar nerve responses. Patients were then asked to score the degree of pain felt from electrical stimulation over each palm using the Wong-Baker Faces Pain Scale (WBFPS) and the Numeric Rating Scale (NRS), independent of baseline pain. Mean WBFPS and NRS scores for lidocaine-treated palms were significantly lower than those for controls using parametric paired t-test (3.79 vs 4.37 and 3.35 vs 3.78 respectively, all p-values<0.05). Subgroup analysis showed a significant decrease in mean scores in females, patients aged ≤50 years, patients without a history of previous NCS, and patients without comorbidities (all p-values<0.05). Median scores using nonparametric Wilcoxon ranked test also showed statistically significant differences (all p-values<0.05). The results indicate that topical lidocaine 2% gel reduces discomfort associated with NCS. However, despite the statistical significance, clear clinical significance may be lacking. Clinical implementation may be considered for the subgroups that showed the greatest benefit. Further studies that incorporate more efficient drug delivery methods may yield better results.

An integrative analysis of genotype-phenotype correlation in Charcot Marie Tooth type 2A disease with MFN2 variants: A case and systematic review

Dominant genetic variants in the mitofusin 2 (MFN2) gene lead to Charcot-Marie-Tooth type 2A (CMT2A), a neurodegenerative disease caused by genetic defects that directly damage axons. In this study, we reported a proband with a pathogenic variant in the GTPase domain of MFN2, c.494A > G (p.His165Arg). To date, at least 184 distinct MFN2 variants identified in 944 independent probands have been reported in 131 references. However, the field of medical genetics has long been challenged by how genetic variation in the MFN2 gene is associated with disease phenotypes. Here, by collating the MFN2 variant data and patient clinical information from Leiden Open Variant Database 3.0, NCBI clinvar database, and available related references in PubMed, we determined the mutation frequency, age of onset, sex ratio, and geographical distribution. Furthermore, the results of an analysis examining the relationship between variants and phenotypes from multiple genetic perspectives indicated that insertion and deletions (indels), copy number variants (CNVs), duplication variants, and nonsense mutations in single nucleotide variants (SNVs) tend to be pathogenic, and the results emphasized the importance of the GTPase domain to the structure and function of MFN2. Overall, three reliable classification methods of MFN2 genotype-phenotype associations provide insights into the prediction of CMT2A disease severity. Of course, there are still many MFN2 variants that have not been given clear clinical significance, which requires clinicians to make more accurate clinical diagnoses.

Exploring the Links Between Dream Experience, Nightmares, Sleep-Related Disturbances, and Subjective Well-Being

The purpose of this study was to investigate the relationship between the subjective experience of dreams, anxiety, and depressive symptoms. Specifically, the study aimed to explore whether the subjective experience of dreams, including how often dreams are remembered, the presence of nightmares, and the way in which a person thinks about dreams, could influence the occurrence of subjective state and trait anxiety, as well as depression. Nightmares, a subset of dreams characterized by high distress and negative tone, were of particular interest, as they can significantly impact a person's well-being and contribute to anxiety and depression. The study also examined the possible influence of recent stress, as well as sleep-related disturbances such as insomnia, difficulty falling asleep, and nocturnal awakenings. A national online survey using Qualtrics forms was utilized to collect the data. The study involved 431 participants (124 males). All participants completed the DQ scale, a questionnaire with a three-factor structure: <i>dream recall</i>, <i>nightmare</i> <i>distress</i>, and <i>dream meaning</i>; the STAI Form Y1-Y2 and the BDI-II. Overall, results suggests that the presence of nightmares is associated with higher levels of depressive distress and increased intensity of both <i>state</i> and <i>trait</i> anxiety. Additionally, the findings indicate that depression is more severe in individuals experiencing recent stress, difficulty falling asleep, and frequent awakenings during the night. Even stable anxious traits of an individual appear to be more intense and contribute to frequent awakenings during the night. The frequency of nightmares is also linked to stress, overexertion, difficulty falling asleep, and frequent awakenings during the night. Interestingly, the memory of dreams is also related to the level of stress experienced by individuals, with those experiencing recent stress tending to recall their dreams more often. Present results are of clear clinical significance providing insight into possible treatment opportunities. Future studies should aim to utilize more representative sample, including different psychiatric populations and individuals with various sleep disorders, to further explore these associations.

Frailty: How to assess, prognostic role

Despite the clear clinical significance of frailty in surgical populations, there is no consensus on how best to define or measure frailty, even within the geriatric literature.A diversity of measures exists to measure some or all these domains, but only research-focused tools have been validated in surgical populations. These tools are too resource-intensive for rapid, cost-effective, preoperative screening of entire populations considering elective surgery.This narrative review deals with the definition of frailty and the different assessment methods of the phenotypic definition and the accumulation of deficits definition.Moreover, as in the area of surgery frailty seems to be an independent risk factor for mortality, morbidity, length of stay, and postoperative complication, different studies reporting the association of preoperative frailty with postoperative outcomes after cancer surgery and the association with postoperative mortality within 30 days are considered. Preoperative careshould include a focus on the goals of treatment and care options. Patient-oriented functional and cognitive outcomes as well as the development and implementation of interventions that could potentially improve adverse postoperative effects must be further investigated.

Uncovering Heterogeneity in Alzheimer's Disease from Graphical Modeling of the Tau Spatiotemporal Topography.

Growing evidence from post-mortem and in vivo studies have demonstrated the substantial variability of tau pathology spreading patterns in Alzheimer's disease(AD). Automated tools for characterizing the heterogeneity of tau pathology will enable a more accurate understanding of the disease and help the development of targeted treatment. In this paper, we propose a Reeb graph representation of tau pathology topography on cortical surfaces using tau PET imaging data. By comparing the spatial and temporal coherence of the Reeb graph representation across subjects, we can build a directed graph to represent the distribution of tau topography over a population, which naturally facilitates the discovery of spatiotemporal subtypes of tau pathology with graph-based clustering. In our experiments, we conducted extensive comparisons with state-of-the-art event-based model on synthetic and large-scale tau PET imaging data from ADNI3 and A4 studies. We demonstrated that our proposed method can more robustly achieve the subtyping of tau pathology with clear clinical significance and demonstrated superior generalization performance than event-based model.

Comprehensive analysis of a homeobox family gene signature in clear cell renal cell carcinoma with regard to prognosis and immune significance

The homeobox (HOX) family genes have been linked to multiple types of tumors, while their effect on malignant behaviors of clear cell renal cell carcinoma (ccRCC) and clinical significance remains largely unknown. Here, we comprehensively analyzed the expression profiles and prognostic value of HOX genes in ccRCC using datasets from The Cancer Genome Atlas (TCGA) and International Cancer Genome Consortium (ICGC) databases. We developed a prognostic signature comprising eight HOX genes (HOXB1, HOXA7, HOXB5, HOXD8, HOXD9, HOXB9, HOXA9, and HOXA11) for overall survival prediction in ccRCC and it allowed patients to be subdivided into high- and low-risk groups. Kaplan-Meier survival analysis in all the internal and external cohorts revealed significant difference in clinical outcome of patients in different risk groups, indicating the satisfactory predictive power of the signature. Additionally, we constructed a prognostic nomogram by integrating signature-derived risk score and clinical factors such as gender, age, T and M status, which might be helpful for clinical decision-making and designing tailored management schedules. Immunological analysis revealed that the regulatory T cells (Tregs) infiltrated differently between the two subgroups in both TCGA and ICGC cohorts. ssGSEA method showed that the enrichment scores for mast cells were significantly lower in high-risk group compared with the low-risk group, which was consistent in both TCGA and ICGC cohorts. As for the related immune function, the enrichment scores of APC co-inhibition, para-inflammation, and type II IFN response were consistently lower in high-risk group in both cohorts. Of the eight HOX genes, the mRNA and protein levels of HOXD8 were downregulated in ccRCC than that in normal tissues, and decreased expression of HOXD8 was associated with increased tumor grade and stage, and lymph node metastasis. Survival analysis revealed that lower expression of HOXD8 predicted worse overall survival in ccRCC. In conclusion, our HOX gene-based signature was a favorable indicator to predict the prognosis of ccRCC cases and associated with immune cell infiltration. HOXD8 might be a tumor suppressor gene in ccRCC and a potential predictor of tumor progression.

Feasibility of video/audio monitoring in the analysis of motion and treatment effects on night-time seizures – Interventional study

The aim of the studyThis pilot study assessed the ability of a video/audio-based seizure monitoring system to evaluate (I) baseline frequency and severity of nocturnal seizures with motor features in patients with drug-resistant epilepsy (DRE) and (II) the individual effect of brivaracetam (BRV) treatment on number, duration and movement intensity of these seizure types. Algorithmic feature analysis was developed for assessment of qualitative changes in movement intensity measurements within seizure types before and after BRV intervention. Materials and methodsNight-time motor seizures of recruited patients were recorded in two separate four-week monitoring periods. The first period defined a prescreening phase (n = 13 patients) to establish a baseline, and the second period defined the intervention phase (n = 9 patients), with BRV initiated during the second week of the second monitoring period. All recorded nights were analyzed by an expert video reviewer, and all unequivocal seizures were classified by an epileptologist.Seizure frequencies using both seizure diaries and video monitoring were compared.The effect of BRV on both seizure duration and movement intensity was assessed by numerical comparison of visual features calculated from motion characteristics of the video, as well as spectral features from the recorded audio. The statistical significance of changes in seizure duration and intensity before and after the intervention were investigated by Wilcoxon rank-sum test and visual inspection of Kernel density estimation. Results8 patients marked seizures in their seizure diaries during the prescreening phase. During the three-week follow-up, three patients achieved > 50% seizure decrease, four patients did not respond to treatment, and two patients experienced worsening of seizures. Five patients were able to document 40–70% of their seizures compared to the video/audio monitoring system. According to the signal feature analysis the intervention decreased movement intensity with clear clinical significance in three patients, whereas statistically significant differences in features appeared in 8 out of 9 patients. ConclusionsThe novel video/audio monitoring system improved the evaluation of treatment effect compared to the seizure diaries and succeeded in providing a comparative intra-patient assessment of the movement intensity and duration of the recorded seizures.

A physical mechanism of heterogeneity and micro-metastasis in stem cells, cancer cells, and cancer stem cells.

Heterogeneity is ubiquitous in stem cells (SC), cancer cells (CS), and cancer SC (CSC). This heterogeneity manifests in the form of diverse sub-populations of SC, CS, and CSC with self-renewal and unique regeneration capacity. Moreover, the progeny of CSC possess multiple plasticity and cancerous characteristics. Many studies have demonstrated that cancer heterogeneity is among the greatest obstacles to successful anti-cancer therapy. This leads to incomplete therapy and transitory efficacy. Furthermore, numerous micro-metastases lead to the spread of tumor cells widely across the body; this is the beginning of metastasis. Epigenetic processes (DNA methylation and histone remodification) represent sources of heterogeneity. In this study, we develop a mathematical model to quantify the heterogeneity of SC, CS, and CSC, taking into consideration both genetic and epigenetic effects. We reveal the roles and physical mechanisms of heterogeneity in SC, CSC, and cancer cells. Under the adiabatic regime (relatively fast regulatory binding and effective coupling among genes), seven native states (SC, CSC, cancer, premalignant, normal, lesion, and hyperplasia) emerge. Under the non-adiabatic regime (relatively slow regulatory binding and effective weak coupling among genes), SC, CS, CSC, and differentiated states emerge and become diffusive, partially explaining the origin of heterogeneity. In other words, slow regulatory binding that mimics epigenetic effects can give rise to heterogeneity. Moreover, we calculated the entropy production rate and Fano factor, which can be used to quantify the thermodynamic cost and the degrees of the variations or the fluctuations as the parameter ω (representing the speed of regulatory binding/unbinding relative to the synthesis/degradation) changes. Elucidating the origins of heterogeneity and the dynamical relationships between intra-tumoral cells has a clear clinical significance and will improve the understanding of the cellular basis of treatment response, therapeutic resistance, and cancer metastasis.

PirePred: An Accurate Online Consensus Tool to Interpret Newborn Screening–Related Genetic Variants in Structural Context

PirePred is a genetic interpretation tool used for a variety of medical conditions investigated in newborn screening programs. The PirePred server retrieves, analyzes, and displays in real time genetic and structural data on 58 genes/proteins associated with medical conditions frequently investigated in the newborn. PirePred analyzes the predictions generated by 15 pathogenicity predictors and applies an optimized majority vote algorithm to classify any possible nonsynonymous single-nucleotide variant as pathogenic, benign, or of uncertain significance. PirePred predictions for variants of clear clinical significance are better than those of any of the individual predictors considered (based on accuracy, sensitivity, and negative predictive value) or are among the best ones (for positive predictive value and Matthews correlation coefficient). PirePred predictions also outperform the comparable in silico predictions offered as supporting evidence, according to American College of Medical Genetics and Genomics guidelines, by VarSome and Franklin. Also, PirePred has very high prediction coverage. To facilitate the molecular interpretation of the missense, nonsense, and frameshift variants in ClinVar, the changing amino acid residue is displayed in its structural context, which is analyzed to provide functional clues. PirePred is an accurate, robust, and easy-to-use tool for clinicians involved in neonatal screening programs and for researchers of related diseases. The server is freely accessible and provides a user-friendly gateway into the structural/functional consequences of genetic variants at the protein level.

Anticoagulation in COVID-19

Anticoagulation in COVID-19

Application analysis of noninvasive prenatal testing for fetal chromosome copy number variations in Chinese laboratories

Objective: To investigate the general situation, detection range, testing reagents, and clinical performance of non-invasive prenatal testing (NIPT) for fetal chromosomal copy number variations (CNVs) in Chinese laboratories. Methods: The National Center for Clinical Laboratories of the National Health Commission designed a questionnaire for the detection of CNVs by NIPT, which included the investigation of whether the laboratory has carried out NIPT to detect CNVs and its testing scope, reagents/platforms, intended uses, screening populations and clinical performance. The questionnaires were distributed to 355 laboratories in 31 provinces, autonomous regions, and municipalities across the country on October, 2020. Further, the feedbacks were statistical analyzed. Results: Two hundred and twenty-eight laboratories had performed NIPT to detect CNVs, including 116 types of CNVs, and more than 95% of laboratories chose to detect the CNVs of 5p15 deletion, 22q11.2 deletion, 1p36 deletion, and 15q11.2 deletion. All testing reagents used were laboratory-developed tests and were based on massive parallel sequencing, the minimum amount of sequencing data was 3-15 M reads, the detection limit of fetal fraction was 3%-5%, and the minimum size of variants that can be detected was 1-5 Mb. The proportion of laboratories that apply CNVs testing for daily project, voluntary requirements of patients, and scientific research were 58.8% (134/228), 57.5% (131/228), and 20.6% (47/228), respectively. One hundred and thirty-four laboratories were fully or partially aware of the clinical performance of NIPT to detect microdeletion/microduplication syndromes, and the laboratories' declared sensitivity of NIPT for Cri du Chat syndrome, 22q11.2 deletion syndrome, 1p36 deletion syndrome, and Angelman syndrome were 50.0%-100%, 60.0%-100%, 50.0%-100%, and 33.3%-100%, and the positive predictive values were 9.0%-50.0%, 18.0%-100%, 20.0%-30.0%, and 20.0%. Conclusion: The detection of CNVs by NIPT in Chinese laboratories need to be standardized. Laboratories should detect CNVs with clear clinical significance in accordance with the guidelines, conduct performance validation of the reagents, then perform NIPT test and provide adequate interpretation after mastering the clinical performance sufficiently.

Protein\u2013protein interaction network analysis applied to DNA copy number profiling suggests new perspectives on the aetiology of Mayer\u2013Rokitansky\u2013K\xfcster\u2013Hauser syndrome

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare disease, characterised by the aplasia of vagina and uterus in women with a 46,XX karyotype. Most cases are sporadic, but familial recurrence has also been described. Herein, we investigated an Italian cohort of 36 unrelated MRKH patients to explore the presence of pathogenic copy number variations (CNVs) by array-CGH and MLPA assays. On the whole, aberrations were found in 9/36 (25%) patients. Interestingly, one patient showed a novel heterozygous microduplication at Xp22.33, not yet described in MRKH patients, containing the PRKX gene. Moreover, a novel duplication of a specific SHOX enhancer was highlighted by MLPA. To predict the potential significance of CNVs in MRKH pathogenesis, we provided a network analysis for protein-coding genes found in the altered genomic regions. Although not all of these genes taken individually showed a clear clinical significance, their combination in a computational network highlighted that the most relevant biological connections are related to the anatomical structure development. In conclusion, the results described in the present study identified novel genetic alterations and interactions that may be likely involved in MRKH phenotype determination, so adding new insights into the complex puzzle of MRKH disease.

Effect of renin-angiotensin-aldosterone system inhibitors on all-cause mortality and major cardiovascular events in patients with diabetes: A meta-analysis focusing on the number needed to treat and minimal clinical effect.

To assess the effectiveness of renin-angiotensin-aldosterone system (RAAS) inhibitors, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) separately to prevent all-cause mortality, myocardial infarction (MI), stroke and heart failure (HF) in patients with diabetes considering the number needed to treat (NNT) and minimal clinical effect (MCE). Data from 17 morbidity-mortality trials in patients with diabetes were used to calculate NNTs and evaluate MCE to prevent all-cause mortality, myocardial infarction, stroke, and heart failure. A total of 17 trials involving 42,037 patients were included in this meta-analysis. Mean follow-up was 3.7 years. ACEIs significantly reduced the risk of all-cause mortality, MI and HF; the corresponding mean NNTBs were 48, 62 and 78, respectively, but ARBs were only associated with a reduction in heart failure. The clinical significance assessment of the included trials indicated that most of the statistically significant trial results had no definitive clinical significance, and only some of them had possible clinical significance. Among patients with diabetes, ACEIs reduced all-cause mortality, MI and HF, whereas ARBs could only prevent HF. However, none of the results of these trials had clear clinical significance, and most had only possible clinical significance.

Surgical Diseases in North Korea: An Overview of North Korean Medical Journals.

Information regarding surgical diseases in North Korea is not fully reported despite their clear clinical significance. The current study aimed to indirectly assess the contemporary research trends and medical infrastructure related to surgical diseases in North Korea. We analyzed and categorized articles from the journal Surgery that were published during the Kim Jong-un era (2012–2018). The framework for categorization was primarily based on disease entities, surgical specialty, and research methodology. A total of 1792 articles in 28 issues were included in the current study. The frequency of detailed surgical cases and their associated characteristics based on their specialty were investigated. The types of medical imaging techniques and anesthetics that were commonly utilized in clinical fields in North Korea were also evaluated. A large proportion of essential surgeries were covered, with the exception of those for congenital diseases; however, a lack of surgical techniques and infrastructure was revealed. Going forward, further evaluation of the surgical system and a greater focus on non-communicable diseases in North Korea are needed.

Post-traumatic hematoma of the “transdural” virtual space. A possible cause of incorrect surgical treatment of epidural hematomas

The space existing between the external and internal dural layer has been anatomically described as a virtual space; no clear clinical significance has been given to it to date. We hereby describe a case of a child with what was expected to be a purely epidural hematoma, at surgery, was found to be composed of two equally coexistent components, one in the epidural space and the second one between the two dural layers. The recognition of a possible involvement of the transdural space in the case of post-traumatic epidural hematomas is relevant for a correct conclusion of the surgical treatment of epidural hematomas, extensively considered basic practice among neurosurgical procedures.

Placental Chorionic Cyst Fluid Has Prothrombotic Properties and Differs From Amniotic Fluid.

Chorionic cysts of the chorion laeve, fetal chorionic plate, septum, and free membranes have been associated with placental hypoxia, but they have no clear clinical significance. Although immunohistochemistry has identified fibronectin and collagen IV in cyst fluid, the contents have yet to be fully characterized. Placental chorionic cysts (N = 10) were sampled by fluid extraction and hemotoxylin and eosin-stained sections. Amniotic fluid samples (N = 8) were obtained from pregnant women who had cytogenetic evaluation. The content of the cysts was tested for thrombogenicity using thromboelastography. The cyst content was tested by Luminex multiplex and ELISA assays and for known prothrombotic and proinflammatory factors. We identified cysts, especially those in the chorionic plate, adjacent to intervillous thrombi with apparent cyst rupture. Thromboelastography revealed a significantly shorter R time compared to whole blood control samples. Concentration of creatinine, α-fetoprotein, and surfactant D in the cyst fluid differed significantly from amniotic fluid. Cyst fluids had a significantly higher expression of all prothrombotic and some proinflammatory factors. Our data provide the first evidence that chorionic cyst fluid is prothrombotic and different from amniotic fluid. The association of ruptured cysts with adjacent thrombi and the prothrombotic properties of cyst fluid suggest a causal relationship; however, further studies are needed.

Role of Routine Abdominal Ultrasound Before Bariatric Surgery: Review of 937 Patients.

Routine use of preoperative abdominal ultrasound for patients undergoing bariatric surgery is controversial. Despite that some physicians routinely implement it, others consider it unnecessary and not cost effective because it does not have a clear clinical significance in the preparation of bariatric patients. To investigate whether routine abdominal ultrasound prior to bariatric surgery affects the surgical plan or not. We reviewed medical records of patients with abdominal ultrasound before bariatric surgery in Rashid Hospital between June 2014 and December 2016. Patients were divided into four groups: group 0 included patients with normal abdominal ultrasound, group 1 included abnormalities that did not affect timing or type of procedure, group 2 included findings that did not affect surgical plan but needed postoperative follow-up, and group 3 included abnormalities that had a direct impact on the procedure. One thousand one hundred twenty files were reviewed. Results were missing in 183 files, thus excluded; remaining 937 files were included. Mean age of patients was 37 ± 12years, 589 (63%) were females and 348 (37%) were males. Mean BMI was 45.1 ± 9.8kg/m2. Ultrasound was normal in 354 (37.7%) of patients and abnormal in 583 (62.3%). Routine abdominal ultrasound does not seem to have an important part in preoperative preparation of patients before bariatric surgery. Further studies could be helpful in discussing this role and building up clear solid evidence and guidelines that could be approved by international bariatric associations regarding the indication of preoperative abdominal ultrasound before bariatric surgery.