Grade II-III Research Articles

Comparing outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in grade II-III hemorrhoidal disease: a retrospective analysis.

Hemorrhoidal disease is a common ailment that presents a challenge in terms of standard treatment methods. Although surgical hemorrhoidectomy is often considered the gold standard, new surgical techniques have emerged, such as laser hemorrhoidoplasty and LigaSure hemorrhoidectomy, to address postoperative pain, bleeding, and extended return-to-work times. This study aims to compare the outcomes of laser hemorrhoidoplasty and LigaSure hemorrhoidectomy in patients with grade II-III hemorrhoidal disease. A retrospective analysis was conducted on a cohort of patients who underwent laser hemorrhoidoplasty or LigaSure hemorrhoidectomy. Data were collected on postoperative pain, complications, recurrence rates, and return-to-work times. The primary outcome was the difference in postoperative pain between the two groups, as assessed using the Visual Analog Scale (VAS). Patients in the laser hemorrhoidoplasty group experienced significantly lower postoperative pain compared to those in the LigaSure hemorrhoidectomy group. Bleeding amounts during the operation were also significantly lower in the laser group. However, the recurrence rate was higher in the laser group compared to the LigaSure group (9.4% versus 2.5%). Return to work and normal activities time after laser hemorrhoidoplasty was shorter than after LigaSure hemorrhoidectomy. Laser hemorrhoidoplasty is a minimally invasive technique that can be safely applied in suitable grade II-III patients, offering lower postoperative pain rates, fewer complications, and shorter return to work and normal activity times compared to LigaSure hemorrhoidectomy. However, recurrence rates are still higher for laser hemorrhoidoplasty. Future studies should explore the potential of combining laser hemorrhoidoplasty with other surgical treatments.

Early in vivo generation of Vγ9Vδ2 T-cells after haploidentical stem cell transplant with post-transplant cyclophosphamide: Updated results of a monocentric phase 1 study.

7050 Background: The presence of donor Vγ9Vδ2 T-cells after haploidentical hematopoietic stem cell transplant (haplo-HSCT) has been associated with improved disease-free survival. These cells, that kill tumor cells in a non-MHC restricted manner and do not induce graft-versus-host disease (GVHD) can be generated by stimulation with bisphosphonate zoledronic acid (ZA), in combination with interleukin-2 (IL-2). Methods: A prospective monocentric phase 1 dose-escalating study aimed at demonstrating the possibility to generate Vγ9Vδ2 T-cells in vivo after haplo-HSCT with post-transplant cyclophosphamide (PTCY). A 3x3 protocol was designed to determine the maximum tolerated dose (MTD) of early administration of increasing low-doses of IL-2 in combination with a fixed dose of ZA, starting the first Monday after day+15 post-transplant. A single dose of 4 mg IV ZA was administered, followed, by subcutaneous injections of IL-2, 5 days/week, for 4 consecutive weeks. Three IL-2 doses were tested: 2, 4 and 6 million UI/infusion. Main inclusion criteria were patients (pts) between 18-70 years old with a hematological disease eligible for haplo-SCT using a Baltimore-based conditioning, no HLA-matched sibling or unrelated donor, no contra-indication to ZA nor IL-2 and informed consent. MTD was defined by the dose just below that which yielded 2/3 or 2/6 dose limiting toxicities (DLT), including severe or recurrent acute GVHD. Vγ9Vδ2 T-cells monitoring was performed in multiparameter flow cytometry on blood samples collected before conditioning, on the day of the first ZA and IL-2 injection, once a week+-3 for 4 weeks and at day +70 post-graft. The protocol was registered at ClinicalTrials.gov as NCT03862833. Results: Twenty-six pts were included between April 2019 and September 2022 (including 7 controls). Three pts withdraw their consents in the experimental group, and 16 pts were treated with ZA and IL-2 (level 1 n = 7 including 1 not evaluable for DLT, level 2 n = 3, level 3 n = 6). First injections occurred at a median of 20 days after Day 0 (range: 17-21). One, 0 and 1 DLT and 4, 2, 2 acute GVHD (all grade II-III) were documented, and MTD was not reached. Vγ9Vδ2 T cells were clearly detectable in both controls and treated pts before conditioning. The median highest value (0.6x106/L, range: 0.0-3.2) was observed at a median of 12 days (8-12) after first infusion of ZA+IL-2. A significantly higher proportion of Vγ9Vδ2 T cells was observed at days +22 and +29 in treated pts compared to controls. At the date of the submission, 3 relapse/progression occurred in treated pts, and 10 are alive in CR. Median OS is not reached. Conclusions: Early in vivo generation of Vγ9Vδ2 T cells is possible after haplo-SCT with PTCY by using a combination of ZA and repeated IL-2 infusions. The DMT has not been reached. This study lays the groundwork for future phase 2/3 studies. Clinical trial information: NCT03862833 .

Hemorrhoidal Artery Ligation for the Treatment of Grade II-III Hemorrhoids: Is it Worth the Use of Doppler Guide in Long-Term Follow-Up?: A Single-Center Cohort Study.

Hemorrhoidal artery ligation (HAL) may reduce postoperative pain and complications and shorten patients' recovery when compared to standard hemorrhoidectomy. It is unclear if the Doppler guide (DG) is useful in reducing recurrence risk. To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade. Between January 1, 2014 and January 31, 2021, 122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy. Mucopexy was routinely performed. After discharge, patients were subjected to 1-week, 1-, 3-, 6-, and 12-month clinical assessment. Thereafter, they were interviewed by telephone annually. Seventy-six (62.3%) DG-HAL and 46 (37.7%) HAL procedures were performed. Median surgical time was 30 (15-45) minutes for DG-HAL versus 25 (15-40) minutes for HAL (P = 0.005). No intraoperative complications occurred. Postoperative bleeding needing surgery occurred in 2 (1.6%) patients in the DG-HAL group. During a median follow-up of 46 months (6-86), we registered 18 (23.7%) recurrences in the DG-HAL group and 13 (28.3%) in the HAL one (P = 0.574). No cases of incontinence or anal stenosis occurred. No significant difference was observed between the two groups in terms of patients' satisfaction. At multivariate analysis, age ≥ 65 years resulted a protective factor for recurrence (odds ratio 0.31; 95% confidence interval 0.09-0.98; P = 0.047). In our study, the use of DG did not reduce recurrence risk. Operative time was significantly increased in the DG-HAL group.

Изменения биомеханики у пациентов с гонартрозом при внутрисуставном введении протеза синовиальной жидкости «Гиапро»

Introduction Deforming osteoarthritis is the most common articular disease, with gonarthrosis accounting for a quarter of the patients aged 50 years and over. The disease is associated with impaired function, pain, disability, reduced quality of life and requires total joint replacement in severe cases. There is no clear understanding of the causes of the disease, however, the pathogenesis is well studied. Intra-articular injection of synovial fluid prostheses including hyaluronic acid is one of the approaches to restore the properties of synovial fluid. Stabilometry that is a rare use in orthopaedics, and no use in this aspect was added to the traditional treatment effectiveness assessment. The objective was to explore biomechanical changes in patients with Kellgren-Lawrence grade II-III gonarthrosis who underwent a series of three knee injections of synovial fluid prosthesis over a period of 6 months. Material and methods An open prospective non-comparative study was performed for 30 patients with unilateral gonarthrosis at a mean age of 60 (56; 63) years. The effect of intra-articular injections of a sterile mannitol heat-stabilized biopolymer synovial fluid prosthesis on the biomechanics was evaluated in two samples using WOMAC score (overall and ≥ 30). Biomechanics was assessed in the form of stabilometry. Standardized stabilography and questionnaires were used at 3 follow-up visits: at 0 month (before administration), at 3 and 6 months. Results General sample showed no cases of true drift of the stabilogram parameters, decreased area of the statokinesiogram, and the WOMAC ≥ 30 sample demonstrated an additional improvement in the speed parameters of vertical oscillation at 6 months, a decreased area of the statokinesiogram at 3 months and at 6 months, decreased energy costs at 6 months (p < 0.05). Discussion Positive changes in stabilometry indicated a decreased pain and fatigue reactions in a vertical static position in gonarthrosis during the treatment. Most effects were statistically significant in moderate and severe dysfunction and pain. Intra-articular injection of synovial fluid prosthesis objectively improved the physiometric parameters of the support reaction. Conclusion Three intra-articular injections of a synovial fluid prosthesis based on mannitol-stabilized hyaluronic acid used in gonarthrosis Kellgren-Lawrence grade II-III showed improved body posture parameters of maintaining upright posture and reduced energy consumption in moderate and severe knee pain according to dynamic stabilometry for at least 6 months.

Electroanatomic mapping system guided His bundle pacemaker implantation: experience of the His bundle registry graz

Abstract Funding Acknowledgements Type of funding sources: None. Background Electric conduction disturbances are very common, however, patients in need for ventricular pacing may suffer from pacing-induced heart failure due to unphysiological pacing by the right ventricular lead. Conducting system pacing allows to overcome this common issue with a more physiologic approach, but real-life procedural data using this technology is scarce. Methods We report a single centre experience of the first 63 consecutive patients being implanted with a His-bundle-based pacemaker 09/2020-11/2022 per 3D-mapping guided implantation due to bradyarrhythmia, or for cardiac resynchronisation therapy in heart failure combined with a left-ventricular lead (HOT-CRT) ± a right ventricular defibrillator lead. The identification of the His-bundle-location was done with a 3D electroanatomic mapping system via an introducing sheath that is provided with electrodes at its tip. Results Mean age was 71 [18;87] years, 18/63 (29%) patients were female, mean baseline LVEF was 46±15%. Baseline ECG was captured before implantation: QRS width was 127±34ms, with typical LBBB in 19/63 (30%), typical RBBB in 5/63 (8%), alternating BBB in two patient (3%) and either no BBB or ventricular escape rhythm in 37/63 (59%). Indications for implantation were AV-block grade II-III in 31/63 (49%), primary prophylactic ICD indication in HFrEF in 18/63 (29%), atrial fibrillation with bradycardic conduction in 8/63 patients (13%), sick-sinus-syndrome in 4/63 (7%) and secondary prophylactic ICD indication in one patient (2%). In 57/63 (90,5%) a primary device was implanted, in 6/63 (9,5%) a pre-existent device was upgraded with a HB lead. Therefore, 23 dual-chamber-pacemaker, 5 single-chamber-pacemaker, 10 single-chamber CRT-P, 17 dual-chamber CRT-P, 4 single-chamber CRT-D, 4 dual-chamber CRT-D were implanted. In 63 patients his bundle pacing was attempted, while in 6/63 (9%) patients outside of this analysis the attempt was not successful, these patients were consecutively implanted with a non-HBP-device and therefor excluded from the further analysis. In the 63 patients included in this analysis with a primary successful pacing at the his-position, 5/63 (8%) his-bundle-leads dislocated within the first 48 hours, leading to a secondary success rate of 92%. There were two post-procedural pneumothorax that needed drainage, no major procedure-related complications occurred. Median skin-to skin procedure time was 111±47 minutes in his-bundle-device-implantation. The paced QRS width at the post-implantation follow up was 113±27ms with a change in QRS width of -15±39ms (+72; -92ms). The mean his-bundle sensing was 5,38±5,6mV and the mean threshold 1,1±0,86V over 1,0±0,5ms (0,4;1,5ms). The proportion of ventricular pacing was 75±36%. Conclusion Electroanatomic-guided His bundle pacing as a new innovative technic for physiological pacing is viable including high implantation success rate as well as electric impact, both regarding QRS width and pacing threshold.

Correlation and clinical significance of VISTA expression and cervical squamous cell carcinoma

Objective: To explore the relationship between the expression of the T-cell activation suppressor-immunoglobulin variable region (VISTA) and the development of cervical squamous cell carcinoma (CSCC), and the impact on the prognosis of CSCC patients. Methods: Cervical tissue samples from 116 CSCC, including 23 cervical intraepithelial neoplasia (CIN) grade I, 23 CIN grade Ⅱ-Ⅲ, and 23 chronic cervicitis patients, were collected from the First Hospital of Soochow University between March 2014 and April 2019. The expression of VISTA in each group was detected by immunohistochemistry (IHC). Survival data of CSCC patients were obtained by follow-up. The survival analysis was performed by Kaplan-Meier method, and survival differences between groups were compared by Log rank test. Prognostic impact factors were analyzed using a multifactorial Cox proportional hazards model. Results: The positive rate of VISTA expression in CSCC group was 32.8% (38/116), and which of grade Ⅱ-Ⅲ was 17.4% (4/23). VISTA expression results showed no positive expression patients in the cervical intraepithelial neoplasia grade I and chronic cervicitis groups. The differences between the CSCC group and other groups were statistically significant (P<0.01). In 116 CSCC patients, VISTA expression was associated with International Federation of Gynecology and Obstetrics (FIGO) stage and lymph node metastasis (P<0.01). The mean survival time of patients in the VISTA positive expression group was 30.7 months, and the 3-year survival rate was 44.7% (17/38). However, the mean survival time of the patients in the VISTA negative expression group was 49.1 months, and the 3-year survival rate was 87.2% (68/78). The Cox regression model found that VISTA expression positivity (P=0.001) and FIGO stage (P=0.047) were prognostic factors for CSCC, and patients with VISTA-positive CSCC had a 4.130-fold risk of death higher than those with VISTA-negative expression. Conclusions: The VISTA protein is highly expressed in CSCC tissues, and its expression level is closely related to the occurrence and development of CSCC. The expression of VISTA can be used as an independent predictor of CSCC prognosis and can provide a strong basis for the treatment of CSCC with immune checkpoint inhibitors.

Postoperative prognostic nomogram for adult grade II/III astrocytoma in the Chinese Han population.

Prognostic models of glioma have been the focus of many studies. However, most of them are based on Western populations. Additionally, because of the complexity of healthcare data in China, it is important to select a suitable model based on existing clinical data. This study aimed to develop and independently validate a nomogram for predicting the overall survival (OS) with newly diagnosed grade II/III astrocytoma after surgery. Data of 472 patients with astrocytoma (grades II-III) were collected from Qilu Hospital as training cohort while data of 250 participants from Linyi People's Hospital were collected as validation cohort. Cox proportional hazards model was used to construct the nomogram and individually predicted 1-, 3-, and 5-year survival probabilities. Calibration ability, and discrimination ability were analyzed in both training and validation cohort. Overall survival was negatively associated with histopathology, age, subtotal resection, multiple tumors, lower KPS and midline tumors. Internal validation and external validation showed good discrimination (The C-index for 1-, 3-, and 5-year survival were 0.791, 0.748, 0.733 in internal validation and 0.754, 0.735, 0.730 in external validation, respectively). The calibration curves showed good agreement between the predicted and actual 1-, 3-, and 5-year OS rates. This is the first nomogram study that integrates common clinicopathological factors to provide an individual probabilistic prognosis prediction for Chinese Han patients with astrocytoma (grades II-III). This model can serve as an easy-to-use tool to advise patients and establish optimized surveillance approaches after surgery. The online version contains supplementary material available at 10.1007/s13755-023-00223-0.

Prognostic value of mitral regurgitation in patients undergoing left ventricular assist device deployment: A systematic review and meta-analysis.

Left ventricular assist devices (LVADs) represent an important therapeutic option for patients progressing to end-stage heart failure. LVAD has previously been shown to have a promising role in improving mitral regurgitation (MR). Nevertheless, the prognostic value of preoperative uncorrected MR in this population remains unclear. A systematic database search with meta-analysis was conducted of comparative original articles of patients with preoperative mild MR (Grade 0-I) versus moderate-severe MR (Grade II-III) undergoing LVAD implantation, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to June 2022. Primary outcomes were overall and operative mortality. Secondary outcomes were neurological dysfunction, gastrointestinal bleeding, right heart failure, LVAD thrombosis, and driveline infection. Our search yielded 2228 relevant studies. A total of 19 studies met the inclusion criteria with a total of 11 873 patients. LVAD caused a statistically significant decrease of 35.9% in the number of patients with moderate-severe MR (grade II-III) postoperatively. No significant difference was observed in terms of overall mortality, operative mortality, GI bleeding, LVAD thrombosis, and driveline infection rates between mild and moderate-severe MR. An increased rate of right heart failure was seen among patients with moderate-severe MR, while lower rates of neurological events were also observed. LVAD improves the haemodynamics of the left ventricle, to promote resolution of MR. Nevertheless, the severity of preoperative mitral regurgitation in patients undergoing LVAD deployment does not seem to affect mortality.

The Impact of Classical Cardiovascular Risk Factors on Hospitalization and Mortality among Hajj Pilgrims.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality during Hajj. The objective of the present study was to examine the effect of classical cardiovascular disease risk factors on mortality and hospitalization among Hajj pilgrims from East Java, Indonesia, during 2017, 2018, and 2019. This study was a retrospective cohort of Hajj pilgrims from East Java, Indonesia, from 2017 to 2019. The data on risk factors were obtained from the pre-embarkation Hajj screening records. The diagnosis of hospitalization and cause of death during the Hajj period were obtained from the medical report and hospital/flight doctor death certificate. A total of 72078 eligible subjects were included in this study. 33807 (46.9%) were men, and 38271 (53.1%) were women, and the majority (35%) were aged between 50 and 59 years. A total of 42446 pilgrims (58.9%) were classified as high risk due to underlying health conditions such as hypertension, diabetes, or if they were aged 60 years or older. The overall hospitalization rate is 971 per 100,000 pilgrims and the overall death rate is 240 deaths per 100,000 pilgrims. Multivariate analysis using logistic regression showed that male gender, age > 50 years, hypertension grade II-III, diabetes, overweight, and obesity were associated with a higher risk of hospitalization. Moreover, male gender, diabetes, and overweight were associated with a higher risk of mortality. Of all hospitalized patients, 92 patients (13.1%) had an initial diagnosis of CVD, and CVD is the main cause of mortality (38.2%) of pilgrims. Pilgrims with classical cardiovascular risk factors were associated with increased hospitalization and mortality.

PD06-04 THE SUB SYMPHYSEAL APPROACH TO THE BLADDER NECK FOR CHILDREN BORN WITH INCONTINENT EPISPADIAS

You have accessJournal of UrologyCME1 Apr 2023PD06-04 THE SUB SYMPHYSEAL APPROACH TO THE BLADDER NECK FOR CHILDREN BORN WITH INCONTINENT EPISPADIAS Moneer Hanna, Mohammed El Menshawy, and Ashraf Fahmy Moneer HannaMoneer Hanna More articles by this author , Mohammed El MenshawyMohammed El Menshawy More articles by this author , and Ashraf FahmyAshraf Fahmy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003230.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To review the outcome of a less invasive surgical approach for plication/ reconstruction of the bladder neck to treat urinary incontinence which may be combined with partial penile disassembly in boys born with epispadias. METHODS: Between 2010 and 2022 a total of 9 children, 6 boys born with penopubic epispadias and 3 girls with incontinent epispadias, all had no prior surgery were operated via the sub symphyseal approach. Their age varied between 3 and 11 years. In boys the urethral plate was first dissected and lifted from the corporal bodies down to the glans penis distally and the wide bladder neck proximally i.e partial penile disassembly. In girls the skin wedge between the crura of the clitoral bodies was raised and tabularized to be used for retraction and further proximal dissection behind the pubic symphysis. The urethra was tubularized over 10 French catheter 10 French catheter, and the bladder neck was plicated over the catheter in 6 children using non absorbable sutures. In 3 children (one boy and 2 girls) the bladder neck was too wide, and a triangular wedge of tissue was excised followed by 2-layer closure with long lasting absorbable sutures around the catheter. The bladder was filled with saline and the water tightness of the suture line and/or the competence of the plicated bladder neck were tested. The corporal bodies are rotated and sutured together to correct the dorsal chordee and the penis is resurfaced by skin. In girls the crural bodies are approximated followed by monsplasty. RESULTS: The follow up ranged between 6 months and 5 years. All boys and 2 girls who were incontinent achieved dryness for 3+ hours and achieved volitional voiding over 6 months postoperatively. One girl exhibited stress incontinence which improved considerably following periurethral injection of bulking agent. The bladder capacity increased from 50- 120 ml preoperatively to 150-230 ml. post-surgery with gradual increase of the bladder capacity over the years. 6/18 renal units showed vesicoureteral reflux (Grade II-III) prior to surgery and were all corrected successfully by endoscopic bulking agent injections. CONCLUSIONS: The sub symphyseal exposure to achieve continence by plicating and/or reconstructing the bladder neck provides a safe and effective surgical approach for children born with incontinent epispadias. Furthermore, in boys it can be combined with penile disassembly. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e156 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Moneer Hanna More articles by this author Mohammed El Menshawy More articles by this author Ashraf Fahmy More articles by this author Expand All Advertisement PDF downloadLoading ...

MP08-07 IS PELVIC LYMPH NODE DISSECTION NECESSARY IN NMIBC PATIENTS UNDERGOING RC?

You have accessJournal of UrologyCME1 Apr 2023MP08-07 IS PELVIC LYMPH NODE DISSECTION NECESSARY IN NMIBC PATIENTS UNDERGOING RC? Qiang Lv, Xiao Yang, Qiang Cao, and Juntao Zhuang Qiang LvQiang Lv More articles by this author , Xiao YangXiao Yang More articles by this author , Qiang CaoQiang Cao More articles by this author , and Juntao ZhuangJuntao Zhuang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003223.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) combined with pelvic lymph node dissection (PLND) is the principle for muscle invasive bladder cancer (MIBC), but it is unclear whether PLND is necessary for high-risk non-muscle invasive bladder cancer (NMIBC). METHODS: From January 2021, patients diagnosed as high-risk NMIBC without swollen lymph nodes (or lymph nodes ≤8mm) on MRI/CT were prospectively enrolled, and randomly received RC+PLND or RC alone (NCT: 05123625). Perioperative clinical data, 90-day complications, and medical expenses, et al were recorded. The endpoint was progression-free survival (PFS) and overall survival (OS). All statistical analyses were performed in SPSS26.0 and R software (version 3.6.3). RESULTS: As of September 19, 2022, a total of 63 patients were enrolled, with 40 patients received ileal conduit, 5 patients received orthotopic neobladder, and 18 received ureteral cutaneous diversion. Among all patients, 26 cases were in RC+PLND group, with the age of 65.5 (IQR: 57.25-72.75) years. Laparoscopic surgery was performed in 15 cases, robotic-assisted in 10 cases, and open surgery in 1 case due to excessive bleeding. Pathological stage was Ta/ Tis: 6 cases and T1: 20 cases. None positive lymph node was found. There were 37 cases in RC only group, with the age of 66 (IQR: 59-73) years. Laparoscopic surgery was performed in 7 cases, and robotic-assisted in 30 cases. Pathological stage was Ta/Tis: 6 cases and T1: 31 cases. The operation time of RC group was significantly shorter than that of RC+PLND group (241±63 min vs. 335±83 min, p < 0.001), and the intraoperative blood loss was significantly lower than that of RC+PLND group (p=0.026). The average daily postoperative drainage volume of patients in RC group was significantly less than that in RC+PLND group (p=0.002), and the time from postoperative to discharge was shorter (8.0±2.4 vs. 11.2±6.3 days, p=0.019). Within 90 days after operation, the incidence of Clavien-Dindo grade II-III complications in RC group were lower than that in RC+PLND group (2.7% vs 19.2%, p=0.073). At the median follow-up of 9.5 (IQR: 6.9-12.8) months, there was no significant difference in PFS and OS between the two groups (Figure 1). CONCLUSIONS: For high-risk NMIBC patients, combined PLND has no survival benefit but increases the incidence of complications. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e95 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Qiang Lv More articles by this author Xiao Yang More articles by this author Qiang Cao More articles by this author Juntao Zhuang More articles by this author Expand All Advertisement PDF downloadLoading ...

Fatty infiltrate and neck muscle volume in individuals with chronic whiplash associated disorders compared to healthy controls – a cross sectional case–control study

BackgroundThe underlying pathophysiological mechanisms of chronic Whiplash Associated Disorders (WAD) are not fully understood. More knowledge of morphology is needed to better understand the disorder, improve diagnostics and treatments. The aim was to investigate dorsal neck muscle volume (MV) and muscle fat infiltration (MFI) in relation to self-reported neck disability among 30 participants with chronic WAD grade II-III compared to 30 matched healthy controls.MethodsMV and MFI at spinal segments C4 through C7 in both sexes with mild- to moderate chronic WAD (n = 20), severe chronic WAD (n = 10), and age- and sex matched healthy controls (n = 30) was compared. Muscles: trapezius, splenius, semispinalis capitis and semispinalis cervicis were segmented by a blinded assessor and analyzed.ResultsHigher MFI was found in right trapezius (p = 0.007, Cohen’s d = 0.9) among participants with severe chronic WAD compared to healthy controls. No other significant difference was found for MFI (p = 0.22–0.95) or MV (p = 0.20–0.76).ConclusionsThere are quantifiable changes in muscle composition of right trapezius on the side of dominant pain and/or symptoms, among participants with severe chronic WAD. No other statistically significant differences were shown for MFI or MV. These findings add knowledge of the association between MFI, muscle size and self-reported neck disability in chronic WAD.Trial registrationNA. This is a cross-sectional case–control embedded in a cohort study.

Is the Combination of Platelet-Rich Plasma and Hyaluronic Acid the Best Injective Treatment for Grade II-III Knee Osteoarthritis? A Prospective Study.

Knee osteoarthritis is a common disease with increasing incidence and prevalence in western countries. It can cause severe pain and functional limitations, thereby representing a threat for patients' quality of life and a burden for national health systems. Intra-articular injections with hyaluronic acid (HA) and platelet-rich plasma (PRP) have been used for decades in order to reduce the symptoms caused by osteoarthritis. In recent years, a combination of HA and PRP has been introduced in clinical practice with the aim to minimize the clinical presentation of osteoarthritis and potentially delay articular degeneration. Sixty cases with grade II-III knee osteoarthritis according to the Kellgren-Lawrence classification were included in a prospective study, focused on the evaluation of clinical and functional outcomes after intra-articular knee injections. Cases were randomly divided into three groups. Twenty cases (Group A) were injected with HA, 20 (Group B) had PRP, and the remaining 20 (Group C) received a combination of HA and PRP. Basal WOMAC score and VAS score were recorded before the treatment and repeated within 3 and 6 months after the treatment. At 6-month follow-up, Group C (PRP + HA) was the one with the lowest WOMAC and VAS mean values. It was also the only group that reported a reduction in the two values both in the first three months and in the following three months. No major complication was recorded. The combination of platelet-rich plasma and hyaluronic acid can be effective in the treatment of grade II-III knee osteoarthritis in a short-to-mid-term scenario. It represents an innovative and valuable alternative to the administration of its two components alone.

Can serum MMP-3 diagnose early knee osteoarthritis?

AimsThis study aims to assess the ability of serum MMP-3 levels to differentiate between normal knee with primary knee osteoarthritis (KOA) and its ability to differentiate between various severity grades. Material & methodsThe study included 80 cases of primary knee osteoarthritis (KOA) and 80 young individuals with no features of KOA. ResultsThe subjects in Case group were younger (52.80 ± 10.31 years) than in Control group (28.55 ± 5.98 years) (p = 0.001). The BMI of Case group (27.5 ± 4.81 kg/m2) was significantly higher than in Control group (25.40 ± 5.71 kg/m2) (p = 0.012). Mean sMMP-3 level in Cases (59.85 ± 39.92 ng/ml) was significantly higher than in Controls (14.52 ± 6.09 ng/ml) (p = 0.0001). There was no gender difference in biomarker values in Cases (p = 0.1) and in Controls (p = 0.88). The level of sMMP-3 rises with increasing age in cases only (p = 0.0001). MMP-3 values were significantly elevated in cases in the sub-categories of BMI within case group and control group (>0.05) but higher in cases in normal, overweight and obese subcategories (p < 0.05). Serum MMP-3 level differs significantly between K-L grade 0-I (p = 0.004), K-L grade I-II (p = 0.000), K-L grade II-III (p = 0.007) and also between K-L grade III-IV (p = 0.02). Biomarker showed moderate positive correlation with KL grade (r = 0.68, p = 0.000) and age (r = 0.38, p = 0.000) and weak positive correlation with WOMAC score (r = 0.289, p = 0.009). The receiver operative curve (ROC) analysis suggested a cut off value of sMMP-3 as 20.03 ng/ml between Control group and Case group, as 12.25 ng/ml between K-L grade 0-I; as 18.37 ng/ml between K-L grade I-II; as 55.60 ng/ml between K-L grade II-III; as 102.0 ng/ml between K-L grade III-IV. ConclusionssMMP-3 estimation as a tool has a good discriminatory power to differentiate between healthy and a diseased knee (KOA) and between severity grades. It can be used as a test to identify individuals with KL grade I and II of KOA.

Abstract No. 40 Embolization of the Superior and Middle Rectal Arteries for the Treatment of Symptomatic Hemorrhoidal Disease using the Combination of Metallic Coils and Microspheres

To investigate the feasibility and initial results of superior and median rectal artery embolization for patients with symptomatic hemorrhoidal bleeding disease. Prospective, single-center cohort that included 10 consecutive patients who underwent superior (SRA) and middle rectal arteries (MRA) embolization with microspheres (1100 μm) and metallic coils, with a follow-up period of 6 months. Embolizations planning and guidance was performed using Embo_ASSIST software with virtual injection (GE Healthcare, IL). Inclusion criteria comprised: Symptomatic hemorrhoidal disease refractory to clinical treatment, and with Goligher classification II or III. Exclusion criteria were previous surgery for hemorrhoidal disease and Goligher classification IV. Technical success was defined as successful catheterization and embolization of the hemorrhoidal arteries using the EmboASSIST software. Hemorrhoid severity (HSS) and the quality of life (QoL) scores were used to evaluate the clinical outcomes. Procedure-related adverse event was defined according to the Society of interventional Radiology in minor or major complications. Ten patients (4 men, 6 women) underwent rectal arteries embolization for hemorrhoidal bleeding disease, with a mean age of 59 (± 13) years old. Goligher classification were level II in 70% and 3 in 30% of patients. Technical success was achieved in all patients. SRA were embolized in 100% and MRA in 80% (90% unilateral and bilateral in 10%). Mean time off work after hospital discharge was 1.4 (±0.7) days. Median procedures time was 102,5 (± 38) minutes. The HSS and QoL scores improved 91% and 85% respectively, without clinical recurrence at the 6 months follow-up (table 1). One patient (10%) had a rectal ischemia that required surgical treatment. Embolization of both superior and middle rectal arteries was feasible and improved symptoms and quality of life in patients with grade II-III hemorrhoidal disease. No clinical recurrence was observed during the first 6-month follow-up.

The impact of a universal late third-trimester scan for fetal growth restriction on perinatal outcomes in term singleton births: A prospective cohort study.

To investigate perinatal mortality, morbidity and obstetric intervention following the introduction of a universal late third-trimester ultrasound scan for growth restriction. Prospective cohort study. Oxfordshire (OUH), UK. Women with a non-anomalous singleton pregnancy undergoing pregnancy care and term delivery at OUH with an estimated due date (EDD) of birth between 1 January 2014 and 30 September 2019. Universal ultrasound for fetal growth restriction between 35+0 and 36+6 weeks was introduced in 2016. The outcomes of the next 18 631 eligible term pregnancies were compared, adjusting for covariates and time, with the previous 18 636 who had clinically indicated ultrasounds only. 'Screen-positives' for growth restriction were managed according to a pre-determined protocol which included non-intervention for some small-for-gestational-age babies. Extended perinatal mortality, a composite of mortality or encephalopathy Grade II-III, and expedited birth. Other outcomes included composite adverse outcomes used elsewhere, detection of low birthweight and birth from 37+0 to 38+6 weeks. Extended perinatal deaths decreased 27% and severe morbidity decreased 33% but neither change was statistically significant (adjusted odd ratio [aOR] 0.53, 95% confidence interval [C1] 00.18-1.56 and aOR 0.71, 95% CI 0.31-1.63). Expedited births changed from 35.2% to 37.7% (aOR 0.99, 95% CI 0.92-1.06). Birthweight (<10th centile) detection using fetal biometry alone was 31.4% and rose to 40.5% if all abnormal scan parameters were used. Improvements in mortality and severe morbidity subsequent to introducing a universal ultrasound for growth restriction are encouraging but remain unclear. Little change in intervention is possible. The antenatal detection of low birthweight remains poor but improves where markers of growth restriction are used.

Adenoid cystic carcinoma of submandibular gland: Emphasis on locoregional metastasis and prognosis.

To analyze the clinicopathological features, locoregional or distant metastasis, and prognosis of adenoid cystic carcinoma of submandibular gland (SMG-AdCC). The clinicopathological data of 80 patients with SMG-AdCC from January 2005 to December 2017 were analyzed retrospectively, and the relationships between different parameters of SMG-AdCC and its locoregional or distant metastasis or prognosis were analyzed. As of December 2019, 41 patients (51.25%) were tumor-free, while 20 patients were found to be living with tumors. The locoregional metastasis rate of grade II-III SMG-AdCC were found to be significantly higher than that of grade I. The five-year DFS and OS rates were 70.8% and 87.1%, respectively. Univariate analysis showed that clinical size, extraglandular extension, pathological grade, pathological node (pN) status, and perineural invasion were correlated with DFS. Multivariate Cox regression analysis showed that pathological grade and extraglandular extension were independent prognostic factors for DFS; pN status and extraglandular extension were independent prognostic factors impacting OS. The pathological grade is a risk factor for locoregional metastasis of SMG-AdCC. Pathological grade, pN status, and status of extraglandular extension are independent prognostic factors for DFS/OS in SMG-AdCC patients.

T1ρ, T2 and T2* mapping of lumbar intervertebral disc degeneration: a comparison study

BackgroundEarly and accurate assessment of lumbar intervertebral disc degeneration (IVDD) is very important to therapeutic strategy. This study aims to correlate and compare the performances of T1ρ, T2 and T2* mapping for Pfirrmann grades and morphologic changes in the IVDD.MethodsThis prospective study included 39 subjects with 195 lumbar discs. T1ρ, T2 and T2* mapping were performed, and T1ρ, T2 and T2* values of nucleus pulposus (NP), and anterior and posterior annulus fibrosus were measured. IVDD was assessed with Pfirrmann grading and morphologic changes (normal, bulging, herniation and annular fissure). The performances of T1ρ, T2 and T2* relaxation times were compared for detecting early (Pfirrmann grade II-III) and advanced degeneration (Pfirrmann grade IV–V), as well as for morphologic changes.ResultsT2 relaxation times was strongly corelated with T1ρ and T2* relaxation times. Areas under the curves (AUCs) of T1ρ, T2 and T2* relaxation times of NP were 0.70, 0.87 and 0.80 for early degeneration, and 0.91, 0.95 and 0.82 for advanced degeneration, respectively. AUCs of T1ρ, T2 and T2* relaxation times of NP were 0.78, 0.83 and 0.64 for bulging discs, 0.87, 0.89 and 0.69 for herniated discs, and 0.79, 0.82 and 0.69 for annular tearing, respectively. The AUC of T2 relaxation time was significantly higher than those of T1ρ relaxation times (both P < 0.01) for early IVDD, and the AUCs of T1ρ and T2 relaxation times for assessing advanced degeneration and morphologic changes were similar (P > 0.05) but significantly higher than that of T2*relaxation time (P < 0.01).ConclusionsT2 mapping performed better than T1ρ mapping for the detection of early IVDD. T1ρ and T2 mapping performed similarly but better than T2* mapping for advanced degeneration and morphologic changes of IVDD.

АССОЦИАЦИЯ ВАРИКОЗНО РАСШИРЕННЫХ ВЕН ПИЩЕВОДА И ЖЕЛУДКА С ДРУГИМИ ФЕНОТИПИЧЕСКИМИ СТИГМАМИ ЦИРРОЗА ПЕЧЕНИ

Background. Portal hypertension resulted from the increased pressure in the portal system is one of the leading syndromes of liver cirrhosis. A frequent and often fatal manifestation of portal hypertension is upper gastrointestinal bleeding mainly due to varicose veins of the esophagus and the stomach. Objective. To study the prevalence of esophageal and gastric varices and their association with other phenotypic stigmas of cirrhosis. Material and methods. A total of 108 patients with cirrhosis, including 46 (42.59%) men and 62 (57.41%) women, were included in the study. Results. Varicose veins were detected in 77 (71,3%) of 108 examined patients. All varices were localized in the esophagus. Of all patients examined, 36 patients (33.33%) were Child-Pugh class A, 58 patients (53.70%) were class B, and 14 patients (12.96%) were class C. Among Class A patients, 9 patients (11.7%) had grade I varicose veins, 9 patients (11.7%) had grade II, 8 patients (10.4%) had grade III, while 13 patients (16.9%), 24 patients (31.2%) and 3 patients (3.9%) had grade B varicose veins, respectively. All patients classified as class C had large varicose veins. The size of varices was associated with the severity of liver cirrhosis (τ=0.2, 95% CI: p˂0.05). Grade II-III varices were seen in 55 patients (50.9%), 9 of whom (16.4%) had a history of gastrointestinal bleeding. Such complication was not observed in any patient with class A cirrhosis, but occurred in all patients with Child-Pugh class C cirrhosis. Conclusions. Patients with liver cirrhosis should undergo follow-up upper GI endoscopy for early detection of varices and, if necessary, for prescription of prophylactic therapy to reduce the risk of bleeding and associated high mortality.

Varicocelectomy improves sperm parameters, sperm DNA integrity as well as the other critical semen features.

Varicocele is a major entity defined within male infertility. In this report we have studied the influence of laparoscopic varicocelectomy on semen quality, biochemical parameters of seminal plasma and sperm DNA fragmentation. In this study, the semen samples from patients with left-side varicocele of grade II-III before and after laparoscopic varicocelectomy were compared to healthy individuals and separated into three groups. The volume of semen, sperm concentration (106/ml), motility (%), viability (%) and normal morphology (%) were assessed. Total antioxidant capacity (TAC), catalase (CAT), superoxide dismutase (SOD) and malondialdehyde (MDA) together with other biochemical substances in seminal plasma as alpha-glucosidase (α-Glu), fructose (Fr) and citric acid (CA) were determined by ELISA method. The spermatozoa activity including ion-transports through sodium, potassium ATPase (Na+, K+-ATPase) and calcium, magnesium ATPase (Ca2+, Mg2+-ATPase) were determined by using spectrophotometry. In addition, flow cytometry method for detection of sperm DNA fragmentation was used. The results showed, that three months after varicocelectomy such intervention led to significant postoperative improvement in volume of semen (p<0.001), total sperm count (p<0.001), sperm motility (p<0.001) and spermatozoa with normal morphology (p<0.001). We found decreased α-Glu levels due to varicocelectomy (p<0.05). There has been shown a high positive correlation between Na+, K+-ATPase and Ca2+, Mg2+-ATPase activity with total number of spermatozoa (p<0.05). The TAC levels and DNA fragmentation values after varicocelectomy can be considered as significant indicators of good prognosis after surgical intervention. It has to be emphasized that α-Glu levels and total sperm count expressed statistically significant both positive and negative predictive values for semen assessment. Varicocelectomy may lead to significant improvement of semen quality although the observations must be correlated with clinical pregnancies observed thereafter.