Group LL Research Articles

Obstetric Outcome and its Relationship with Mode of Delivery in Preterm Labour- A Study of 86 Patients in Combined Military Hospital, Dhaka

Background: Caesarean section in preterm pregnancy may add further pressure to the already existing poorly developed facilities for intensive perinatal care in low resource countries. The objective of the study was to determine the feto-maternal outcome and its relationship with mode of delivery in preterm labour. Methods: This was a descriptive type of cross-sectional study conducted at Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Dhaka, during March to August 20l8. The study population was total eighty-six patients having 28 to 36 weeks of gestation who were admitted in the above department and were in labour. Data were edited and analyzed by using computer-based software, statistical package for social sciences (SPSS) version 20.0. Results: Majority of the patients belonged to 26-30 years age group and were from low socioeconomic family (71.4 to 72.7) % and had below average nutritional status (88.1 to 93.2) %. The mean gestational age was 31 weeks and 35 weeks. Nulliparous (77.3 to 85.7) % and patients taking irregular antenatal check-up (69.0 to 72.8) % were predominant. About (59.1 to 66.7) % patients had vaginal delivery and (33.3 to 40.9) % patients had undergone caesarean section. Maternal morbidity was more in caesarean section (37.5%) than vaginal delivery (33.3%). Live birth babies were found 100% in caesarean section and 94.4% in vaginal delivery and among them 95.7% were from group I and 97.6% were from group ll. Perinatal mortality was higher in vaginal delivery than caesarean section (7.40% vs 2.7%) and also higher in group I than group ll (8.3% vs 2.3%). But late perinatal complications were more in caesarean section (47.2%) than vaginal delivery (45.1%) baby, and majority (60%) of them were from group l. Conclusion: Preterm pregnancy when leads to an early delivery, brings a grave consequence for both the mother and foetus. After birth, the premature newborn is at risk for complications related to incomplete development of its organ system. Caesarean section delivery in preterm labour improves foetal outcome to some extent, but not significantly, and leads the mother to more maternal morbidity. Perinatal mortality and morbidity is also inversely related to the gestational age at the time of delivery, in preterm labour - more the gestational age, less the perinatal mortality and morbidity. Bangladesh Armed Forces Med J Vol 57 No (1) June 2024, pp 43-49

A High Immediate Postoperative Systemic Immune-inflammation Index Is Associated With Postoperative Symptomatic Cerebral Infarction in Moyamoya Patients Undergoing Combined Revascularization Surgery.

Inflammation plays a role in the pathogenesis of cerebral infarction. Postoperative symptomatic cerebral infarction (SCI) is a complication after revascularization surgery in patients with moyamoya disease (MMD). We investigated the association between the systemic-immune-inflammation index (SII) and postoperative SCI during hospital stay in such patients. Perioperative data were retrospectively obtained from 681 MMD patients who underwent revascularization surgery. SII cutoff values were identified as those where the sum of sensitivity and specificity associated with SCI were highest. Patients were divided into 4 subgroups according to the preoperative and immediate postoperative cutoff SII: HH (preoperative and postoperative SII high, n=22), LH (low preoperative and high postoperative SII, n=68), HL (high preoperative and low postoperative SII, n=125), and LL (preoperative and postoperative SII low, n=466). Postoperative SCI occurred in 54 (7.6%) patients. The cutoff values for preoperative and immediate postoperative SII were 641.3 and 1925.4, respectively. Postoperative SCI during hospital stay was more frequent in the high postoperative SII group than in the low postoperative SII group (25.6% vs. 4.9%; P<0.001). Multivariate analysis revealed that a high immediate postoperative SII was a predictor of postoperative SCI (odds ratio, 11.61; 95% CI: 5.20-26.00; P<0.001). Postoperative SCI was lower in group LL than in group LH (3.6% vs. 23.5%, P<0.008) and was lower in group HL than in groups HH and LH (9.6% vs. 31.8% and 23.5%, both P<0.05). A high immediate postoperative SII was associated with postoperative SCI during hospital stay in MMD patients who underwent revascularization surgery.

An Analysis on Link of Maternal Lipid Profile and Gestational Diabetes Mellitus: A Case Control Study of 120 Women

BACKGROUND: Gestational diabetes mellitus GDM is a clinical condition, or disease, wherein, a marked reduction in the sensitivity of insulin, during pregnancy, is attributed to the metabolic disturbance that occurs widespread. Although, information on the association among dyslipidaemia and GDM remains uncertain till date. The main objective of the present investigation is to detect any correlation between lipid profile of GDM subjects and healthy control women,using biochemical indicators. METHODS: A careful clinical case study was performed, involving a total of 120 subjects, comprising two distinct groups. Group I includes 60 pregnant women, those were recently detected as GDM cases. Group ll covers healthy control subjects collected from Open Patients unit and Registry of Diabetic Unit of Dhanalakshmi Srinivasan Institute Medical science and Hospital, Perambalur, Tamil Nadu. Both groups' subjects were bifurcated, based on their age groups, and found to be 25 to 45 years. Estimation of glycemic condition, in prior and post fasting was performed, using an analyzer appropriately. Similarly, maternal lipid profile for both groups was also determined. Moreover, HbAl c, an important biochemical indicator was also detected for both groups of subjects with respect to their age, using HPLC technique. Received data were pooled and a statistical analysis was performed, using Student t test to identify the significance difference or association between GDM group and healthy subjects, in specific, on the maternal lipid profile. FINDING: Analysis showed that there is a significant difference observed in the maternal lipid profile of GDM group, when compared with healthy subjects. The P value of Very Low Lipid protein VLDL, low density lipoprotein LDL, High density lipoprotein HDL was found to be 0.01, 0.028, and 0.038 respectively. Whereas, p value for HbAl c was recorded as 0.02, and found significant difference at 0.01 percent level. Interestingly, no difference was observed in the limit of FG, and Triglycerides limit, and were reported as p _0.28, and p- 0.316 respectively. A marked difference was also detected among the 30 to 35 yrs age group. INTERPRETATION: Present investigation elucidated that there is a strong correlation between GDM subjects and dyslipidemia. Further, this study strengthened and promised that elevated maternal lipid profile is highly linked with GDM condition.

Microleakage of two resin composites by using different light curing systems

This study was conducted to evaluate marginal microleakage of two resineomposite (Glacier resin composite and Filtek P 60 resin composite) either cured witheonventional light cure unit ( Astralis 5) or light emitting diodes (LED) light cure unit»Radii). Forty class V cavities were prepared in 20 extracted second premolars, onebuccaly and one palataly in each tooth. Each cavity was located lmm coronal toeementoenamel junction and lmm apical to it. The teeth were randomly divided into 4groups, each group of five teeth (I0 cavities): Group I was filled with Glacier resincomposite and cured with LED curing unit. Group ll filled with Glacier and curedin ith Astralis 5 curing unit. Group lll filled with Filtek P60 resin composite and curedv- ith LED curing unit. Group IV filled with Filtek P 60 and cured with Astralis curingxnit. The teeth were stored in distilled water for seven days. Then the apices of theteeth were sealed with sticky wax and the teeth were covered with two layers of nailvamish except lmm around the restoration. The teeth were immersed in 0.5% basicfaehsin dye for 24 hours at 37°C in the incubator and then were longitudinallyxctioned in a buccolingual direction and the extent of dye penetration was recorded.The statistical analysis of the result revealed that the use of LED light cure unit,results in highly significant reduction in the microleakage occlusally and gingivally

Correlation of Prostate Volume, Uroflowmetry Variables and BMI in Patients Having Clinical Benign Prostatic Hyperplasia.

Background: Benign Prostatic Hyperplasia (BPH) causing urinary obstruction is a common entity in a man over 40 years old. Enlarge prostate causes compression of the prostatic part of the urethra leading to bladder outflow obstruction, causes LUTs (lower urinary tract symptoms) of BPH and decreases quality of life.Objectives: To find out the correlation of prostate volume, and BMI with Uroflowmetry variables, of patients having BPH symptoms.Materials and Methods: A total of 44 patients having BPH symptoms, ages ranging from 48 to 85 years, who underwent transabdominal ultrasound and uroflowmetry in a standing position, were included in this study. The patients were divided into 4 age groups and 4 grades of prostate size for comparison. Height in cm and weight in Kg were recorded for BMI calculation.Results: Among the patients, the mean age was 66.25, with a mean prostate size of 39.73 g, with a Qmax of 14.45 ml/sec, Qave 5.96 ml/sec, mean voided volume 327.14 ml and PVR 57.91 ml with mean flow time 61 sec.In age group l, there were 3 patients, ages ranged 40 to 50 years. In age group ll, there were 11 patients, age range 51 to 60 years. In age group lll, there were 17 patients, ages ranged 61 to 70 years. In age group lV, there were 13 patients, age range 71 to 84 years. In grade l of prostate size (prostate &lt;30 g), there were 13 patients. In grade ll prostate size (prostate 30-&lt;50 g ), there were 25 patients. In grade lll, prostate size (50- &lt;85 g), there were 4 patients. In grade lV (prostate size is &gt;85 g), there were 2 patients. No significant difference was found among 4 age groups and 4 grades of prostate volume. However, there was a weak correlation between prostate size and uroflowmetry variables without a significant difference.Conclusion: There was a correlation between prostate volume and different uroflowmetry variables of age-related groups and grades of the prostate but the correlation was weak. KYAMC Journal Volume: 14, No: 03, October 2023: 138-144.

Propensity score matched analysis and risk stratification of donors with G6PD deficiency in living donor liver transplantation.

Glucose 6 phosphate dehydrogenase (G6PD) deficiency (G6PDd) can trigger hemolysis following surgical stress. Differentiating G6PDd-related post-operative hemolytic episodes (PHE) and post-hepatectomy liver failure may be challenging especially in living donors where donor safety is paramount. We analysed outcomes of our cohort of G6PDd liver donors. G6PDd individuals with no evidence of hemolysis were considered as living donors if there was no alternative family donor. Outcomes of G6PDd donors undergoing left lateral/left lobe donation (Group LL) and right lobe donation (Group RL) were compared with non-G6PDd donors matched in a 1:3 ratio using propensity score matching. 59 G6PDd donors (5.8% of 1011) underwent living donor hepatectomy (LiDH) during the study period. LL-G6PDd donors (22.37%) had higher post-operative peak bilirubin level compared to matched controls, but no difference in morbidity or need for post-operative blood transfusion.RL-G6PDd donors (37.63%) had higher peak bilirubin level, morbidity (16.2% vs. 3.6%, p = 0.017) and more post-operative blood transfusion (21.6% vs. 6.4%, p = 0.023) as compared to matched non-G6PDd cohort. Four RL-G6PDd donors (10.8%) developed PHE. Low G6PD activity (15% vs. 40%, p = 0.034) and lower future liver remnant (FLR) (34.3% vs. 37.8%, p = 0.05) were identified as risk factors for PHE. We report the largest to-date series of G6PDd individuals undergoing LiDH and confirm the safety of LL donation in G6PDd. Our analysis identifies specific risk factors for PHE and suggests that right lobe LiDH be avoided in individuals with less than 25% G6PD activity when the FLR is less than 36%.

VACCINATION OF CALVES WITH LIVE MODIFIED AND LIVE VIRULENT STRAIN OF SALMONELLA TYPHIMURIUM

Sixteen normal colostrum-fed -Friesian and Holestein-Friesian X Angus crossbred calves, ranging in age from 2 to 7 weeks were divided into 4 vaccinated groups and 1 nonvaccinated (control) group. Group I consisted of 2 calves vaccinated orally twice at a two week interval with small doses of organisms ( 104 thar1l05 live virulent Salmonella gghimurium, strain 108-11). Group ll consisted of 2 calves vaccinated orally twice at two weeks interval with 1011 organisms (modified Salmonella typhimurium, strain SL 3261 ). Group [[1 consisted of 2 calves vaccinatedlivitwice at two weeks interval with small doses of organisms ( 104 than 105 virulent Salmonella typhimurigg, strain 108-11). Group IV consisted of 3 calves which were vaccinated 1M twice atv/o weeks interval with109 live modified strain 108-11(SL 1479). Group V consisted of 7 calves which served as nonvaccinated controls. One to two weeks after the final vaccine close all calves were orally challenge exposedwith 1.5x 1011 viable Salmonella typliimurium, strain 108-11. The results of vaccination with different preparation of vaccine indicated that a modified live vaccine strain designated as SL 1479 with complete, nonreverting blocks in aromatic biosynthesis may beappropriate for protecting domestic animals against Salmonella infection.

Predictive power of portal pressure gradient remeasured shortly after transjugular intrahepatic portosystemic shunt.

The portal pressure gradient (PPG) measured at the time of transjugular intrahepatic portosystemic shunt (TIPS) completion (immediate PPG) is easily disturbed by many factors. This study aimed to assess the diagnostic value of PPG remeasured 2-4days after TIPS (delayed PPG) by comparison with immediate PPG. We retrospectively analyzed cirrhotic patients aged 18-75years who received TIPS for preventing variceal rebleeding and pressure measurements at different time points. Of 154 eligible patients, 60 (39.0%), 62 (40.3%), and 32 (20.8%) were categorized into group LL (both immediate and delayed PPG < 12mmHg), LH (immediate PPG < but delayed PPG ≥ 12mmHg) and HH (both immediate and delayed PPG ≥ 12mmHg), respectively. Mean immediate and delayed PPG were 9.2mmHg and 12.8mmHg (p < 0.001). During a median follow-up of 22months, the 1-year probability of variceal rebleeding was significantly lower in groupLL (1.7%) compared to LH (9.8%, absolute risk difference [ARD]: - 8.2%, p = 0.028) and HH (12.6%, ARD: - 11.1%, p = 0.014), but was not significantly different between groups LH and HH (ARD: - 2.9%, p = 0.671). Delayed PPG (p < 0.001) was identified as an independent predictor of variceal rebleeding in multivariable Cox regression analysis. The area under curves of delayed and immediate PPG in predicting variceal rebleeding were 0.837 and 0.693 for all patients (p = 0.031), and 0.936 and 0.694 for patients without shunt dysfunction (p < 0.001). In cirrhotic patients with variceal bleeding, delayed PPG has higher predictive power for variceal rebleeding than immediate PPG.

COMPARISION OF INTRAVENOUS MIDAZOLAM/ KETAMINE WITH DEXMEDETOMIDINE-PROPOFOL COMBINATION FOR SEDOANALGESIA IN ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY( ERCP) PROCEDURES IN TERTIARY CARE HOSPITAL

Background:Endoscopic retrograde cholangiopancreatography (ERCP), often require sedation during the procedure. The most commonly used drugs for this purpose are midazolam and propofol, which are used as sedative and hypnotic agents with minimal analgesic potential. Aims &amp; objectives:Effects of Sedoanalgesia with Midazolam/ ketamine long with Dexmedetomidine nfusion &amp; Rescue propofol alliquotes regimes on hemodynamic and respiratory variables&amp; recovery profile in patients undergoing ERCP. Methods:In this Retrospective observational study adult patients of ASA grade l- lll were enrolled after taking inform consent from patient &amp; their relatives. Premedication was given in form of inj.Midazolam 0.02 mg/kg iv in Group l,.inj ketamine 0.5 mg/kg iv was given in group ll. Inj.Dexmedetomidine ( bolus dose of 1 μg/kg over 10 min) followed by 0.5μg/kg/hour as maintenance in both the groups.intermittent Intravenous Propofol alliquotes was used for maintain BIS 70-80 in both groups. Amount of propofol used during procedure was notified.. Hemodynamic and respiratory variables, recovery time and adverse events were monitored &amp; recorded. Results:The hemodynamic and respiratory variables were similar in both groups. Total propofol consumption was significantly lower in the group ll. (205+/-80 mg vs.155+/-20 mg p &lt; 0.001). The recovery period was shorter in group ll (time to achieve the Aldrete score 9 was 9.0 ±2.2 vs. , 6.2+/-1.1min p &lt; 0.001).Adverse events were comparable between the two groups. Conclusion:Ketamine-Dexmedetomidine combination with propofol may be a safe and useful alternative for sedation for ERCP patients.

Evaluation of Pneumatic Vs Holmium: YAG Laser Lithotripsy in the Treatment of Ureteric Stone

&#x0D; ABSTRACT &#x0D; Background and objectives: Among many lithotripters for fragmentation of ureteric stones, pneumatic and Holmium: YAG laser lithotripsy has reported favorable outcomes. The aim of this study is to compare the efficacy of pneumatic lithotripsy with laser lithotripsy in ureteral stone.&#x0D; Materials and methods: In this prospective study, 60 patients with diagnosis of ureteral calculus underwent ureteroscopic lithotripsy in Urology Unit, Department Surgery, National Medical College and Teaching Hospital over period of 2020 to 2021. They were divided randomly into two groups, each group with 30 patients.&#x0D; Group PL was treated with Pneumatic lithotripsy and Group LL was treated with Holmium: YAG laser lithotripsy. History and detailed clinical examination was performed as per the working proforma which included. Result of both the procedures was assessed. Chi square test were used for correlation analysis. Data analysis was done using SPSS (Statistical Package for social sciences), version 25.&#x0D; Results: Mean age was 26.5 years and 36.33 years in group PL and LL respectively (P=0.58), there was no significant difference in male to female ratio and mean stone in both groups. Duration of operation was significantly lower in LL group and Hospital was slight lower in LL group as compare to PL group (0.95).&#x0D; Conclusion: Ho:YAG laser and pneumatic lithotripsy are efficient and safe procedures for ureteral stones. Though operative time is higher in pneumatic lithotripsy.

Stability of blood eosinophils in acute exacerbation of chronic obstructive pulmonary disease and its relationship to clinical outcomes: a prospective cohort study

BackgroundThe clinical value of blood eosinophils and their stability in chronic obstructive pulmonary disease (COPD) remains controversial. There are limited studies on association between the stability of blood eosinophils in acute exacerbation of COPD (AECOPD) and clinical outcomes. This study aimed to evaluate the stability of blood eosinophils in hospitalized AECOPD and its relationship to clinical outcomes.MethodsThis prospective observational study recruited patients hospitalized with AECOPD from November 2016 to July 2020. The eligible patients were divided into four groups according to their blood eosinophil counts at admission and discharge: persistently < 300 cells/μl (LL), < 300 cells/μl at admission but ≥ 300 cells/µl at discharge (LH), ≥ 300 cells/μl at admission but < 300 cells/µl at discharge (HL), and persistently ≥ 300 cells/μl (HH). Cox hazard analyses were used to study the association between eosinophil changes and exacerbations or mortality.ResultsIn 530 patients included, 90 (17.0%) had a high blood eosinophil count (BEC) ≥ 300 cells/µl at admission but 32 (35.6%) of them showed a decreased BEC at discharge. The proportions and distribution for group LL, LH, HL, and HH were 381 (71.9%), 59 (11.1%), 32 (6.0%), and 58 (10.9%), respectively. During hospitalization, the LH group had a higher C-reactive protein level, higher rate of intensive care unit (ICU) admission, and higher total cost. The length of hospital stay of the LH group was longer compared with group LL, HL, or HH (P = 0.002, 0.017, and 0.001, respectively). During a follow-up of 12 months, the HH group was associated with a higher risk of moderate-to-severe exacerbations compared to the LL group (hazard ratio 2.00, 95% confidence interval 1.30–3.08, P = 0.002). Eosinophil changes had no significant association with mortality at 12 months. Sensitivity analyses in patients without asthma and without use of systemic corticosteroids prior to admission did not alter the results.ConclusionsMore attention should be paid to the LH group when evaluating the short-term prognosis of AECOPD. A persistently high BEC was a risk factor for long-term exacerbations. Eosinophil changes during hospitalization could help to predict outcomes.

Pituitary and ovarian hormones: is their plasma concentration affected by litter size in primiparous lactating rabbit does?

Genetic selection in commercial rabbit lines based on litter size has positively improved the number of kits suckling, presumably to weaning. Although it has been proven that the energetic balance of primiparous does is due to the need to satisfy pregnancy, lactation and growth requirements, litter size adjustment from 7 to 12 kits is applied as a routine in commercial rabbit farms. The suckling stimulus provokes a prolactin (PRL) secretion, which in turn can modulate the preovulatory release of luteinising hormone (LH) and, consequently, the ovulatory and productive responses of the does. This study aimed to determine if litter size of prolific primiparous rabbit does during lactation [Group HL, with high litter density (10-12 kits; n=21) and Group LL, with low litter density (7-9 kits; n=29)] influences plasma concentration of PRL. Blood samples from lactating does were taken weekly throughout lactation starting on day 4 post-partum, until day 32 post-partum, before and immediately after suckling. In addition, the does were re-inseminated after weaning (day 32 post-partum), and sampled at 0 and 60 min after induction of ovulation to determine whether litter size affected the peak of LH, progesterone (P4) concentrations and the main productive parameters of their second pregnancy. All hormones were determined by enzyme immunoassay. Statistical analysis of the results revealed that the PRL concentrations of hyperprolific rabbit does before and immediately after a suckling stimulus from 7-9 or 10-12 kits were significanltly different, as we only detected basal levels, with a rise after weaning in both groups. More studies are necessary, delaying blood sampling to later periods of time after the suckling stimulus, in order to conclude whether the peak release of this hormone is altered or not. There were also no differences in plasma LH and progesterone levels after artificial insemination, or in productive performance of these females after their second pregnancy. In conclusion, the litter size adjustment of prolific primiparous rabbits with 7 to 12 kits determines adequate pituitary, ovarian and reproductive responses at second parturition if the does are inseminated after weaning.

Prognostic significance of the postoperative prognostic nutritional index in patients with glioblastoma: a retrospective study

BackgroundThe prognostic nutritional index (PNI) reflects immunonutritional status. We evaluated the effects of postoperative PNI and perioperative changes in the PNI on overall survival (OS) in glioblastoma (GBM) patients.MethodsDemographic, laboratory, and clinical data were retrospectively collected from 335 GBM patients. Preoperative and postoperative PNIs were calculated from serum albumin concentration and lymphocyte count, which were measured within 3 weeks before surgery and 1 month after surgery. Patients were classified into high (n = 206) or low (n = 129) postoperative PNI groups according to the postoperative PNI cutoff value and further classified into four groups according to the cutoff values of the preoperative and postoperative PNIs, as follows: Group HH (both high PNIs, n = 92), Group HL (high preoperative and low postoperative PNI, n = 70), Group LH (low preoperative and high postoperative PNI, n = 37), and Group LL (both low PNIs, n = 136).ResultsThe median OS was significantly longer in the high postoperative PNI (PNI ≥ 50.2) group than the low postoperative PNI (PNI < 50.2) group (24.0 vs. 15.0 months, p < 0.001). In multivariate analysis, high postoperative PNI was a significant predictor of OS. OS was significantly longer in Group HH than in Group LL and seemed longer in Group HH than in Group HL and in Group LH than in Group LL. OS was not different between Groups HH and LH or between Groups HL and LL.ConclusionsHigh postoperative PNI was associated with improved OS and perioperative changes in PNI may provide additional important information for prognostic prediction in GBM patients.

Lysine supplemented to poultry by‐product meal replacement diet modulates body growth, metabolism and related gene expressions of hybrid sturgeon (Acipenser schrenckii ♀ × Acipenser baerii ♂)

Hybrid sturgeon (Acipenser schrenckii♀×Acipenser baerii♂) were fed with four isonitrogenous (approximately 43.0%) and isolipidic (approximately 13.6%) diets: FM-based diet (lysine control diet, LC diet), poultry by-product meal totally substitute diet (lysine low diet, LL diet), LL diet supplemented lysine to match the LC diet group level (lysine medium diet, LM diet) and LL diet supplemented lysine over the LC diet group level (lysine high diet, LH diet) for 8 weeks to determinate the effect of dietary lysine supplementation on growth performance, metabolism and immunity response. The results indicated that compared with control diet, LL diet led to depressed growth performance and feed utilization. Lysine supplementation had a significant effect on improving the growth performance and feed utilization. Moreover, LL diet also decreased the plasma-free amino acid concentration, nutrient content and mRNA expression level of IGF system and increased plasma immunity indexes and gene expression level of HSP70 than the control diet. LM diet had marked efficiency to eliminate the differential effects caused by lysine insufficiency. However, high-level lysine addition had undesirable effect on regulating the growth performance, feed utilization, plasma-free amino acid concentration, nutrient content, immunity indexes and gene expression level. Present study demonstrated that poultry by-product meal with lysine addition could totally substitute FM without adverse effects on growth performance, plasma AA concentration, nutrient content and immune response in hybrid sturgeon. Our results provide a solid evidence for using lysine to improve the body growth performance and metabolism in hybrid sturgeon.

Effects of Systemic Lidocaine on Postoperative Recovery Quality and Immune Function in Patients Undergoing Laparoscopic Radical Gastrectomy

ObjectiveThis study aimed to explore the effects of lidocaine on postoperative quality of recovery (QoR) and immune function in patients undergoing laparoscopic radical gastrectomy.MethodsIn total, 135 patients were enrolled and were equally randomized to receive low-dose lidocaine (Group LL: 1.5 mg/kg bolus followed by an infusion at 1.0 mg/kg/hour) or high-dose lidocaine (Group HL: 1.5 mg/kg bolus followed by an infusion at 2.0 mg/kg/hour) or Controls (Group C: received a volume-matched normal saline at the same rate). The primary outcome was a QoR-40 score on postoperative day (POD) 1. Secondary outcomes were a QoR-40 score on POD 3, levels of inflammatory factors (IL-6, IL-10, TNF-α) and CD4+T cells, CD8+T cells proportions, and CD4+/CD8+ cell ratios and postoperative recovery of bowel function.ResultsThere were no statistically significant differences in patient characteristics at baseline. The total QoR-40 scores on POD 1 in Group HL (171.4±3.89) were higher than those in Group LL (166.20±4.05) and in Group C (163.40±4.38) (adjusted P<0.001). Differences in the dimension scores of QoR-40 for pain, physical comfort, and emotional state were significant across the three groups. Lidocaine administration significantly reduced the release of IL-6, IL-10, TNF-α, and attenuated immune changes induced by trauma. Kaplan–Meier curves showed that the median time to the first exhaust and defecation were shorter in the Group HL than in Groups LL and C (1.55 days vs 2.4 days vs 2.6 days, log rank P<0.0001; and 2.86 days vs 3.22 days vs 3.46 days, log rank P=0.002, respectively). Additionally, patients in lidocaine groups required less remifentanil consumption and experienced lower pain intensity, compared with the control group.ConclusionSystemic lidocaine improved postoperative recovery, alleviated inflammation and immunosuppression, and accelerated the return of bowel function, and is thus, worthy of clinical application.Clinical Trials RegistrationChiCTR2000028934.

Impacts of stage 1 palliation and pre-Glenn pulmonary artery pressure on long-term outcomes after Fontan operation.

The present study was aiming to determine whether high mean pulmonary artery pressure before bidirectional cavopulmonary shunt is a risk factor for late adverse events in patients with low pulmonary artery pressure before total cavopulmonary connection (TCPC). We retrospectively reviewed the medical records of all patients undergoing both bidirectional cavopulmonary shunt and TCPC with available cardiac catheterization data. A total of 316 patients were included in this study. The patients were divided into 4 groups according to mean pulmonary pressure: those with pre-Glenn <16 mmHg and pre-Fontan <10 mmHg (Group LL, n = 124), those with pre-Glenn ≥16 mmHg and pre-Fontan <10 mmHg (Group HL, n = 61), those with pre-Glenn <16 mmHg and pre-Fontan ≥10 mmHg (Group LH, n = 66) and those with pre-Glenn ≥16 mmHg and pre-Fontan ≥10 mmHg (Group HH, n = 65). Group HL showed significantly higher rate of adverse events after TCPC than Group LL (P = 0.02). In univariate linear analysis, a history of atrial septectomy at stage 1 palliation was associated with low pre-Glenn mean pulmonary artery pressure (Coefficient B -1.38, 95% confidence interval -2.53 to -0.24; P = 0.02), while pulmonary artery banding was a significant risk factor for elevated pre-Fontan mean pulmonary artery pressure (Coefficient B 1.68, 95% confidence interval 0.81 to 2.56, P < 0.001). High mean pulmonary artery pressure before bidirectional cavopulmoary shunt (≥16mmHg) remains a significant risk factor for adverse events after TCPC even though mean pulmonary artery pressure decreased below 10 mmHg before TCPC.

Mortality Rates of EUS-Guided Biliary Drainage (EUS-BD) in Malignant Biliary Obstruction Patients in EUS-BD Era versus Non-EUS-BD Era: A Retrospective Cohort Study

Introduction: Most of the Cholangiocarcinoma (CCA) patients are commonly found in an advanced stage and often presents with Malignant Biliary Obstruction (MBO). Palliative treatment using biliary drainage plays a major role in the treatment modalities. However, only a few studies with small number of subjects have reported their long term outcomes. Aim: To compare the mortality rates of MBO patients in Endoscopic Ultrasound-guided Biliary Drainage (EUS-BD) era versus non-EUS-BD era. Materials and Methods: The present study was a retrospective cohort study which enrolled 132 MBO patients who had received palliative treatment between January 2014 to August 2020 at Thabo Crown Prince Hospital, Nong Khai, Thailand. The patients were treated either with EUS-BD (group l, n=30) or non-EUS-BD (group ll, n=94). Due to imbalance of follow-up time between two groups, the Overall Survival (OS) rates were compared using parametric survival analysis with restricted mean difference at 12 months follow-up, adjusted by other covariates, and presented in term of Kaplan-Meier curve, Hazard Ratio (HR) and 95% confidence interval. Results: Most of the patients (99.19%) were having CCA. The clinical characteristics between the two groups showed no significant difference, except the mean follow-up time that group II was shorter than group I (2.43 vs. 7.12 months; p&lt;0.001). At 12 months after treatment, the OS rate of group I remained significantly higher than group II (mean difference=2.23; 95%CI: 0.54-3.92; p=0.010). The parametric-Cox proportional hazard model showed that the 1-year mortality of patients in group I were 63% less than those in group II, the parametric model between two groups showed statistical significance with p-value=0.043. Conclusion: From present study it can be concluded that EUS-BD in MBO patients achieves lower mortality rate at one year follow-up. For conclusive findings of the benefit of EUS-BD, a prospective long term study with larger numbers of subjects should be performed.

Ibrutinib Induces Durable Remissions in Treatment-Naïve CLL Patients with 17p Deletion/TP53 Mutations: Five Year Follow-up from a Phase 2 Study

Ibrutinib Induces Durable Remissions in Treatment-Naïve CLL Patients with 17p Deletion/TP53 Mutations: Five Year Follow-up from a Phase 2 Study

Long-Term Follow-up of the Combination of Low-Intensity Chemotherapy Plus Inotuzumab Ozogamicin with or without Blinatumomab in Patients with Relapsed-Refractory Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia: A Phase 2 Trial

Long-Term Follow-up of the Combination of Low-Intensity Chemotherapy Plus Inotuzumab Ozogamicin with or without Blinatumomab in Patients with Relapsed-Refractory Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia: A Phase 2 Trial

Long-Term Efficacy of First-Line Ibrutinib Treatment for Chronic Lymphocytic Leukemia (CLL) With 4 Years of Follow-Up in Patients With TP53 Aberrations (del(17p) or TP53 Mutation): A Pooled Analysis From 4 Clinical Trials

Background : The presence of TP53 aberrations (defined as del(17p) or TP53 gene mutation) is a strong negative predictor of survival in patients (pts) with CLL. First-line chemoimmunotherapy is suboptimal in pts with CLL bearing TP53 aberrations, with 3-year progression-free survival (PFS) and overall survival (OS) rates of only 18% and 38%, respectively, with fludarabine, cyclophosphamide, and rituximab (Hallek, Lancet 2010). Ibrutinib is the only once-daily Bruton's tyrosine kinase (BTK) inhibitor with significant PFS and OS benefit demonstrated in multiple randomized phase 3 studies (eg, RESONATE-2, ECOG1912) in the first-line treatment of CLL/small lymphocytic lymphoma (SLL). Previous reports of single-agent ibrutinib or ibrutinib-based combination treatments have further demonstrated favorable PFS benefit in pts with TP53 aberrations in both the first-line and relapsed/refractory settings. Despite these study-specific subgroup analyses, there are limited data on long-term outcomes in pts with TP53 aberrations treated with first-line BTK inhibitors. We performed a pooled analysis of data across 4 studies to evaluate the long-term efficacy and safety of first-line ibrutinib-based therapy in pts with CLL bearing TP53 aberrations. Methods : Data for first-line ibrutinib treatment in pts with TP53 aberrations were pooled across 4 clinical trials in CLL/SLL: PCYC-1122e (NCT01500733; single-agent ibrutinib; n=34), PCYC-1130 (NCT02264574; ibrutinib + obinutuzumab; n=18), ECOG1912 (NCT02048813; ibrutinib + rituximab; n=26), and RESONATE-2 (NCT01722487; single-agent ibrutinib; n=11). ECOG1912 and RESONATE-2 excluded pts with del(17p) but did not exclude pts with TP53 mutations. Long-term PFS (assessed by investigator), OS, and safety are reported. Results : Eighty-nine pts with TP53 aberrations receiving first-line ibrutinib treatment were included in this pooled analysis. Median age was 65 years (range 33-87), and 69% of pts were male. At baseline, 53% had Rai stage III/IV, 38% had bulky disease (lymph nodes ≥5 cm), and 69% (of 87 evaluable) had unmutated IGHV. All patients had either del(17p) or TP53 mutation; 53% (of 89 evaluable) had del(17p) and 91% (of 58 evaluable) had TP53 mutation. Among 16 pts with del(17p) who had TP53 sequencing results available, 11 (69%) had both del(17p) and TP53 mutation. Forty-five pts received ibrutinib as a single agent and 44 received ibrutinib in combination with an anti-CD20 agent. With a median follow-up of 50 months (range 0.1 to 95.9 months), median PFS was not reached (95% CI: 67 months to not estimable; Figure 1A). At 48 months, the PFS rate was 79% and the OS rate was 88% (Figure 1B). Median duration of ibrutinib treatment was 46 months (range 0.1 to 95.5 months). Reasons for treatment discontinuation were progressive disease (20%), study closure (12%), adverse event (10%), withdrawal by pt (7%), death (3%), and other (physician decision due to scheduled pt surgery; 1%). Grade ≥3 adverse events of clinical interest with up to 8 years of treatment with ibrutinib were infection (22%; most commonly pneumonia in 7%), hypertension (13%), atrial fibrillation (12%), and major hemorrhage (7%). With the current follow-up, 46% of pts with TP53 aberrations remained on ibrutinib treatment. Conclusions : With a median follow-up of 4 years, first-line ibrutinib-based treatment resulted in sustained efficacy with high PFS and OS rates in CLL pts with TP53 aberrations, a population with historically poor outcomes. Although pts with TP53 aberrations remain at risk for progression, first-line treatment with ibrutinib has partially overcome the poor prognosis in this high-risk population with 4-year PFS and OS rates of 79% and 88%, respectively. No new safety signals were identified in this analysis. These results from a large, pooled, multi-study dataset demonstrated the long-term benefit of first-line ibrutinib-based treatment in pts with TP53 aberrations. Disclosures Allan: Janssen, AbbVie, and AstraZeneca: Other: Travel/accommodations/expenses; Celgene, Genentech, AstraZeneca, TG Therapeutics, and Janssen: Research Funding; AstraZeneca, Pharmacyclics LLC, an AbbVie Company, Genentech, AbbVie, Ascentage, and Cellectar: Consultancy; Janssen, AstraZeneca, and AbbVie: Honoraria. Shanafelt:Genentech, Pharmacyclics LLC, an AbbVie Company, AbbVie, GlaxoSmithKline, and Merck: Research Funding; Mayo Clinic: Patents &amp; Royalties: and other intellectual property. Wiestner:Pharmacyclics LLC, an AbbVie Company; Acerta, Merck, Nurix, Verastem, and Genmab: Research Funding; National Institutes of Health: Patents &amp; Royalties: and other intellectual property. Moreno:Janssen, AbbVie, Sunesis, and AstraZeneca: Consultancy; AbbVie and Janssen: Research Funding; Janssen: Speakers Bureau. O'Brien:Eisai: Consultancy; Juno Therapeutics: Consultancy; Aptose Biosciences: Consultancy; GlaxoSmithKline: Consultancy; Sunesis: Research Funding; Acerta: Research Funding; Amgen: Consultancy; Celgene: Consultancy; Pfizer: Research Funding; Pharmacyclics: Research Funding; Astellas: Consultancy; Gilead: Consultancy; TG Therapeutics: Research Funding; Vida Ventures: Consultancy; KITE: Research Funding; Vaniam Group LL: Consultancy; Alexion: Consultancy; Regeneron: Research Funding; AbbVie: Consultancy; Verastem: Consultancy; Janssen Oncology: Consultancy. Braggio:DASA: Consultancy; Bayer: Other: Stock Owner; Acerta Pharma: Research Funding. Liu:AbbVie: Current equity holder in publicly-traded company; Pharmacyclics LLC, an AbbVie Company: Current Employment. Dean:AbbVie: Current equity holder in publicly-traded company; Pharmacyclics LLC, an AbbVie Company: Current Employment. Lai:Pharmacyclics LLC, an AbbVie Company: Current Employment; AbbVie and Bristol-Myers Squibb: Current equity holder in publicly-traded company; AbbVie: Other: Travel/accommodations/expenses.