Number Of Patients In Group Research Articles

Possible Predictive Factors for In-hospital Cardiac Arrest in Patients with Cancer: A Retrospective Single Center Study.

Background: Despite cancer being the second most common cause of death in the United States, more people are living longer after the diagnosis of cancer than before. Healthcare workers will be treating an increasing number of patients with cancer. Various studies have identified predictors of cardiac arrest in the general population, however, none have been done to identify such factors in cancer patients who form a more vulnerable group with lower survival rate following cardiac arrest.Methods: We retrospectively analysed charts of all patients with active cancer who experienced in-hospital cardiac arrest (IHCA) and underwent cardio-pulmonary resuscitation (CPR) from January 2015 to December 2017 at our hospital (n=44, group A). We compared this group to 44 consecutive patients with active cancer admitted to the oncology unit who did not experience cardiac arrest (n=44, group B). We excluded patients in remission.Results: Both the groups were comparable in terms of age (69 ± 14 vs 68 ± 15, p=0.776) and gender distribution (50% vs 56% males, p=0.521). Prevalence of coronary artery disease (CAD) (25% vs 11%, p=0.097), hypertension (68% vs 66%, p=0.821), hyperlipidaemia (34% in both groups, p=1.000), tobacco abuse (18% vs 27%, p=0.308), and diabetes mellitus (34% vs 23%, p=0.237) was not significantly different between the two groups. Group with cardiac arrest had significantly higher alanine aminotransferase (100 U/L ± 150 vs 47 U/L ± 87, p=0.043), alkaline phosphatase (288 U/L ± 512 vs 118 U/L ± 80, p=0.032), creatinine (1.8 mg/dl ± 1.74 vs 1.1 mg/dl ± 0.76, p=0.023), international normalised ratio (INR) (2.1 ± 1.5 vs 1.2 ± 0.5, p=0.005), and lower estimated -glomerular filtration rate (43 mL/min/1.73m2 ± 17 vs 51 mL/min/1.73m2 ± 15, p=0.022) on admission. Group A also had significantly higher incidence of sepsis during the hospital course as compared to group B (30% vs 2%, p<0.001). In group A, 11.4% survived to discharge as compared to 95.5% in group B. Significantly higher number of patients in group B were taking chemotherapy (77.27% vs 34.09%, p=0.000046) and radiation therapy (65.9% vs 22.72%, p=0.000046) as compared to group A.Conclusion: Cancer patients who experienced IHCA had worse renal and hepatic function; they were frequently diagnosed with sepsis and had similar cardiovascular risk factors as compared to cancer patients who did not experience cardiac arrest. Furthermore, a higher number of patients with active cancer who did not experience cardiac arrest were on chemotherapy, immunotherapy or radiation therapy.

Sequencing of Taxanes and New Androgen-targeted Therapies in Metastatic Castration-resistant Prostate Cancer: Results of the International Multicentre Retrospective CATS Database

BackgroundThe optimal sequence of life-extending therapies in metastatic castration-resistant prostate cancer (mCRPC) is unknown. ObjectiveTo evaluate outcomes among mCRPC patients treated with docetaxel (DOC), cabazitaxel (CABA), and a novel androgen receptor–targeted agent (ART; abiraterone acetate or enzalutamide) according to three different sequences. Design, setting, and participantsData from 669 consecutive mCRPC patients were retrospectively collected between November 2012 and October 2016. Outcome measurements and statistical analysisThe primary endpoint was the prostate-specific antigen (PSA) response (decrease ≥50% from baseline) to each therapy. Secondary endpoints included best clinical benefit, time to PSA progression, radiological progression-free survival (rPFS), overall survival (OS), and toxicity. Results and limitationsA total of 158 patients received DOC→CABA→ART (group 1), 456 received DOC→ART→CABA (group 2), and 55 received ART→DOC→CABA (group 3). At baseline, PSA progression only and Gleason <8 were more common in group 3. PSA response on DOC was lower in group 3 than in other groups (p=0.02) and PSA response on CABA was higher in the second than in the third line (p=0.001). In Group 3, rPFS on ART (6.6 mo) and DOC (9.2 mo) was also shorter than in the other groups. OS calculated from the first life-extending therapy reached 34.8, 35.8, and 28.9 mo in groups 1, 2 and 3, respectively (p=0.007). Toxicity was comparable between the arms. The main limitations of the trial are its retrospective design and the low number of patients in group 3. ConclusionsIn this retrospective trial, sequencing of DOC, CABA, and one ART, was associated with median OS of up to 35.8 mo. CABA seemed to retain its activity regardless of treatment sequence. DOC activity after ART appeared to be reduced, but the data are insufficient to conclude that cross-resistance occurs. Patient summaryThe order of drugs administered to patients with metastatic castration-resistant prostate cancer could impact their efficacy, with cabazitaxel appearing to retain its activity whatever the therapeutic sequence.

Prognostic and Predictive Value of HER2 Amplification in Patients With Metastatic Colorectal Cancer

PurposeTo evaluate a prognostic and predictive value of HER2 amplification in patients with metastatic colorectal cancer (mCRC). Patients and MethodsPatients with mCRC who underwent surgical resection of the primary tumor and who received best supportive care with or without palliative chemotherapy between 2005 and 2015 were included. HER2 immunohistochemistry was performed using formalin-fixed, paraffin-embedded primary tumor specimens. HER2 amplification was confirmed by fluorescence in-situ hybridization. The RAS and BRAFV600E mutations were centrally assessed using a PCR-based method. Patients were divided into 4 subgroups: R (RAS mutant), B (BRAFV600E mutant), H (wild-type RAS/BRAF with HER2 amplification), and W (wild-type RAS/BRAF without HER2 amplification). Overall survival (OS) and progression-free survival of anti–epidermal growth factor receptor (EGFR) therapy were assessed. ResultsAmong 370 eligible patients, data of 359 were successfully analyzed. Fifteen tumors harbored HER2 amplifications, including 4 tumors with concomitant RAS mutation (group R). The number of patients in groups R, B, H, and W was 204, 13, 11, and 131, respectively. The median OS was 27.4 months, and the median follow-up time was 63.2 months. The median OS for groups R, B, H, and W was 24.0, 14.2, 19.9, and 39.1 months, respectively. The number of patients who received anti-EGFR therapy in groups R, B, H, and W was 17, 4, 5, and 49, respectively. Progression-free survival of anti-EGFR therapy was significantly shorter in groups R, B, and H than in group W. ConclusionHER2 amplification was predictive of anti-EGFR therapy response and appeared to be prognostic in mCRC patients.

MP79-13 NOCTURNAL ANTIDIURESIS AFTER ADMINISTRATION OF IMIDAFENACIN IS INDUCED BY CONCENTRATION OF URINE OSMOLALITY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction II1 Apr 2018MP79-13 NOCTURNAL ANTIDIURESIS AFTER ADMINISTRATION OF IMIDAFENACIN IS INDUCED BY CONCENTRATION OF URINE OSMOLALITY Mamoru Hashimoto, Nobutaka Shimizu, Tomoki Takahashi, Koichi Sugimoto, Takafumi Minami, Hirotsugu Uemura, and Akihide Hirayama Mamoru HashimotoMamoru Hashimoto More articles by this author , Nobutaka ShimizuNobutaka Shimizu More articles by this author , Tomoki TakahashiTomoki Takahashi More articles by this author , Koichi SugimotoKoichi Sugimoto More articles by this author , Takafumi MinamiTakafumi Minami More articles by this author , Hirotsugu UemuraHirotsugu Uemura More articles by this author , and Akihide HirayamaAkihide Hirayama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2681AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Imidafenacin is one of the anti-cholinergic drugs with high affinity to muscarinic type 3 receptor used for alleviating OAB symptoms. Recently, Yamazaki T [1] published data of imidafenacin with inhibitory effects on antidiuretic hormone (ADH) related pathway. We hypothesized that imidafenacin-induced decrease of urine volume at night might be derived from concentration of urine osmolality (Uosm) as a result of inhibiting ADH related pathway (Figure modified from [2] indicates possible mechanism of imidafenacin inhibiting that pathway). This is the first study to evaluate the effectiveness of imidafenacin on Uosm in clinical practice. METHODS A total of 43 OAB patients who had never been administered anti-cholinergic agents were entered in the study. The numbers of male and female patients were 25 and 18, respectively. We examined Uosm, urinary Na/Cre ratio at first void in the morning, nocturnal polyuria index (Npi) based on frequency volume charts, International Prostate Symptom Score (IPSS), over active bladder symptom score (OABSS), maximum urinary flow (Qmax) and residual urine (RU) every four weeks until the 8 weeks visit after administration of imidafenacin. We also classified the patients into two groups according to whether Uosm decreased (Group A) or not (Group B) at 8 weeks visit compared to the baseline. RESULTS Following the administration of imidafenacin, IPSS and OABSS improved significantly in all 43 patients. Npi decreased significantly, and Uosm, urinary Na/Cre ratio, Qmax and RU did not change at 8 weeks visit. The number of patients in Groups A and B was 17 and 18, respectively. Npi decreased significantly only in Group A [Table], which suggested that imidafenacin reduced Npi due to the concentration of Uosm. CONCLUSIONS The beneficial effects of nocturnal antidiuresis after administration of imidafenacin is attributable to the concentration of Uosm. 1. Eur J Pharmacol. 2016 Nov 15;791:72-77. 2. Adv Physiol Educ. 2009 Dec;33(4):270-4. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1085-e1086 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Mamoru Hashimoto More articles by this author Nobutaka Shimizu More articles by this author Tomoki Takahashi More articles by this author Koichi Sugimoto More articles by this author Takafumi Minami More articles by this author Hirotsugu Uemura More articles by this author Akihide Hirayama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Survival prediction based on qualitative MRI diffusion signature in patients with recurrent high grade glioma treated with bevacizumab.

Bevacizumab was approved by the FDA for the treatment of recurrent or progressive glioblastoma (GBM). Imaging responses are typically assessed by gadolinium-enhanced MRI. We sought to determine the significance of qualitative diffusion signature (manifest as variable degree of dark signal) on ADC maps in recurrent gliomas after treatment with bevacizumab. We performed an institutional review board (IRB) approved retrospective study on patients who underwent MRI of the brain after 8 weeks of receiving bevacizumab for recurrent glioma. Patients were divided into three groups based on qualitative diffusion signature: (I) lesion not bright on diffusion weighted imaging (DWI) suggestive of no restricted diffusion (FDR0); (II) lesion bright on DWI with corresponding homogenous dark signal on apparent diffusion coefficient (ADC) maps suggestive of focal restricted diffusion likely due to bevacizumab induced necrosis (FDRn); and (III) lesion bright on DWI with corresponding homogenous faint dark signal on ADC maps suggestive of focal restricted diffusion likely due to viable tumor or heterogeneous spectrum of dark and faint dark signals on ADC maps suggestive of focal restricted diffusion likely due to viable tumor surrounding the bevacizumab induced necrosis (FDRt). Based on the qualitative signal on diffusion weighted sequences after bevacizumab therapy, total number of patients in group (I) were 14 (36%), in group (II) were 17 (44%); and in group (III) were 8 (20%). The median overall survival (OS) from the time of recurrence in patients belonging to group (II) was 364 days vs. 183 days for those with group (I) vs. 298 days for group (III). On simultaneous comparison of survival differences in all three groups by Kaplan-Meier analysis, group (II) was significant in predicting survival with P values for the log-rank tests <0.033. In patients with recurrent glioma treated with bevacizumab, the presence of homogenous dark signal (FDRn) on ADC maps at 8 weeks follow-up MRI correlated with a longer survival. Thus, use of this qualitative diffusion signature in adjunct to contrast enhanced MRI may have the widest potential impact on routine clinical care for patients with recurrent high-grade gliomas. However, prospective studies analysing its predictive value are warranted.

Evaluation of Depression Associated With Post-Traumatic Stress Disorder After Maxillofacial Injuries—A Prospective Study

Maxillofacial injuries can result in psychological derangement, leading to post-traumatic stress disorder (PTSD), which is characterized by continual re-experiencing of any traumatic event in addition to numerous systemic complications. The objective of this study was to assess the incidence and severity of "PTSD-related depression" in patients with maxillofacial injuries and to identify the risk factors involved. This prospective study involved 88 patients with maxillofacial trauma who had only cosmetic deficits (group A), only functional deficits (group B), or cosmetic and functional deficits (group C). The psychological status of all patients was assessed before and after surgery using Zung's Self-Rating Depression Scale. Remission time also was analyzed. Data were analyzed with SPSS 22.0 using parametric methods. Comparison of mean values among groups was performed using 1-way analysis of variance followed by Tukey honest significance difference post hoc tests for multiple pairwise comparisons. To compare proportions, the χ2 test was applied. The number of patients in groups A, B, and C was 11, 34 and 43, respectively. In the immediate post-trauma stage, all patients in group A showed severe depression; the percentages of patients with severe depression in groups B and C were 8.8 and 81.4%, respectively, which was statistically relevant. Depression scores of patients of all groups decreased gradually in the postsurgical phase. Patients with cosmetic defects consistently recorded higher depression scores at all intervals. The time taken for recovery from depression (remission time) was shorter for patients with only functional deficits (group B). Patients with maxillofacial injuries are prone to PTSD-related depression from functional and cosmetic deficits. The objectives of trauma management must be aimed at restoring pre-trauma form and function of the maxillofacial skeleton and the patient's psychological status.

Fungal Prophylaxis with a Gastro-Resistant Posaconazole Tablet for Patients with Hematological Malignancies in the POSANANTES Study.

Posaconazole is an antifungal drug used in both prophylaxis and treatment of invasive fungal infections. Its oral formulation requires therapeutic drug monitoring. To overcome gastric acidity, a gastro-resistant posaconazole tablet has recently been developed. POSANANTES was a prospective noninterventional study that aimed to monitor plasma concentration trough level (Cmin) of posaconazole tablets used prophylactically in patients with hematological malignancies. Fifty patients were included. Group A (n = 31) included patients receiving induction chemotherapy for myeloid malignancies, and group B (n = 19) included patients treated for graft-versus-host disease after allogeneic hematopoietic stem cells transplantation. In multivariate analysis, female sex, group B assignment, and evaluation of Cmin at day 8 (versus any other day planned by the analysis) were associated with a higher Cmin, while diarrhea was associated with a lower Cmin (P < 0.05). Thirty-four percent (n = 17) of all included patients had to prematurely stop treatment, mainly in group A. In conclusion, this real-life prospective study showed good absorption of posaconazole tablets used for prophylaxis in patients with hematological malignancies, even though this strategy was somewhat limited due to the high number of patients in group A who had to stop their treatment in an untimely fashion.

Influence of the shape of Nd:YAG capsulotomy on visual acuity and refraction

Background Posterior capsule opacification (PCO) is a common complication after cataract surgery. The need for PCO prevention becomes increasingly important. During the past decades, various forms of prevention have been examined, including general measures during surgery, pharmacological prevention, and by interfering with the biological processes of epithelial mesenchymal transformation (EMT) in lining epithelial cells (LECs). The first-line treatment option is posterior capsulotomy performed with a neodymium:yttrium–aluminum–garnet (Nd:YAG) laser. To evaluate the influence of the size and shape of Nd:YAG laser capsulotomy on visual acuity and refraction. Patients and methods We evaluated 20 eyes of 20 patients treated with Nd:YAG laser posterior capsulotomy for PCO. Patients were divided into two groups according to the shape of capsulotomy: patients with cruciate shape capsulotomies with openings of more than 3 mm (group 1) and patients with circular shape capsulotomies of more than 3 mm. Results The mean number and energy of laser firings were significantly higher in group 2 and significantly lower in group 1 (P=0.011). In the preprocedural spherical equivalent, there was no statistical significance between the two groups (P=0.971). In the postprocedural spherical equivalent also there was no statistical significance between the two groups (P=0.643). Significant change in intraocular pressure following capsulotomy was observed in group 2 (P=0.011), but there was no significant change in group 1. A higher number of patients in group 2 and a lower number of patients in group 1 report floating bodies after YAG laser capsulotomy (P≤0.050 significant). Regarding floating bodies there was statistical significance between the two groups (P=0.025). Best-corrected visual acuity highly significantly improved following capsulotomy in both the groups (P≤0.001). Conclusion Cruciate shape capsulotomy provides improvement in visual function with minimal complications.

Comparison of Fentanyl and Dexmedetomidine as Intrathecal Adjuvants to Spinal Anaesthesia for Abdominal Hysterectomy

Spinal anaesthesia, although advantageous for conducting abdominal hysterectomy, is not the first choice amongst surgeons for fear of intra-operative visceral pain. Intrathecal adjuvants may improve quality of spinal anaesthesia. This study aims to compare efficacy of intrathecal Fentanyl and Dexmedetomidine to reduce visceral pain during abdominal hysterectomy performed under spinal anaesthesia. Sixty women undergoing abdominal hysterectomy for benign indications were randomly assigned to two equal groups in a double-blind fashion. Fentanyl 25 micrograms in group A or Dexmedetomidine 10 micrograms in group B was co-administered with hyperbaric Bupivacaine 15 milligrams for spinal anesthesia. Surgery through Pfannenstiel incision proceeded once sensory block reached eighth thoracic dermatome. The intra-operative visceral pain was assessed using a five-point scale: none, mild, intermediate, severe, and failed spinal anaesthesia. Duration of analgesia and peri-operative events were studied for 24 hours. Chi-square test, Mann-Whitney U-test and Student's t-test were used for analysis. Level of significance used was P<0.05. Fifty eight participants completed the study. Demographic variables and sensory block were similar between groups. General anaesthesia was not required in both groups. Significantly greater number of patients in group A required medications for visceral pain with Relative Risk of 2.8 (1.16-6.7). Pruritus and shivering occurred significantly higher in group A. Hypotension was significantly higher in group B. Post-operatively, group B patients showed a significantly longer duration of analgesia. Dexmedetomidine is better than Fentanyl as an intrathecal adjuvant to spinal anaesthesia in minimizing visceral pain during abdominal hysterectomy and in prolonging post-operative analgesia.

Comparison of efficacy and safety of transdermal buprenorphine patch applied 48 versus 72 hours preoperatively in providing adequate postoperative analgesia following major abdominal surgeries

Introduction: A transdermal drug delivery system provides steady and continuous drug delivery. As the onset of action is delayed, it has to be applied preoperatively to provide optimal postoperative analgesia. Aim: To compare the efficacy and safety of transdermal buprenorphine patches applied 48 and 72 h preoperatively in providing adequate postoperative analgesia following major abdominal surgeries and the incidence of side effects. Materials and Methods: This prospective randomized, double-blinded study was conducted in a tertiary care institution. Thirty patients undergoing laparotomy were recruited. Group A (n = 15) received a transdermal buprenorphine 10 mg patch with a delivery rate of 10 μg/h, which was applied approximately 48 h before surgery, whereas in group B (n = 15) buprenorphine 10 mg patch was applied 72 h preoperatively. All patients received general anesthesia following standardized protocol. Postoperative pain was assessed using numerical rating scale (NRS). The Mann–Whitney U test and independent t-test were used for statistical analysis. Results: NRS was significantly high in group A for up to 30 h postoperatively as compared to group B. From 36 to 48 h, it was comparable. The need for rescue analgesia was significantly high in group A as compared to group B. Significant number of patients in group B experienced nausea and vomiting (53.33% vs. 26.67%) and sedation (20% vs. 13.33%) in the preoperative period. Conclusion: Transdermal buprenorphine patch applied 72 h preoperatively provided better analgesia than the one applied 48 h before surgery. However, its preoperative use in patients without painful conditions predisposes them to develop side effects.

Metabolic syndrome and cardiovascular disease risk assessment among human immunodeficiency virus-infected individuals on antiretroviral therapy.

Background:The association of cardiovascular risk with first-line antiretroviral therapy (ART) in Indians has been a matter of concern with the background of a high risk in South Asians.Aims:This study aimed to compare metabolic syndrome and its components, dyslipidemia, insulin resistance, and cardiovascular risk among patients on first-line ART (Group 1) with age-matched, ART-naïve human immunodeficiency virus (HIV)-infected patients (Group 2) and normal controls (Group 3).Methods:Patients attending a tertiary care center in Mysore were enrolled in the study after obtaining informed consent and controls were chosen from relatives of patients.Results:The total number of patients enrolled in the study was 217 (males 111; females 106), and the mean age of these patients was 34.1 ± 7.4 years. The number of patients in Group 1 (HIV+, ART experienced) was 76; in Group 2 (HIV+, ART naïve) was 71, and in Group 3 (HIV−) was 70. There was no statistically significant difference in the prevalence of metabolic syndrome between the three groups. On comparing the components of metabolic syndrome, serum triglycerides (mg/dl) were significantly higher in the ART group (Group 1: 149.5 [interquartile range (IQR): 84–187], Group 2: 108 [IQR: 74–152], and Group 3: 141.5 [IQR: 89–192]; P = 0.014) and serum high-density lipoprotein cholesterol was higher in HIV-uninfected individuals (Group 1: 37.5 ± 11.83, Group 2: 31.5 ± 12.23, and Group 3: 40.1 ± 12.09; P = 0.0002). There was no association between metabolic syndrome, duration of HIV, and type of first-line ART. Total and low-density lipoprotein (LDL) cholesterol were significantly higher in the ART group. Homeostatic model assessment and Framingham scores did not reveal any significant difference across the three groups.Conclusion:HIV-infected individuals on ART had higher levels of triglycerides, LDL, and total cholesterol, but no increased cardiovascular risk compared to other groups.

Comparative Study between Lidocaine 2% and Dexamethasone Local Wound Infiltration Effect on Postoperative Pain Post Mastectomy: A Randomized Controlled Study

Objective: To compare the efficacy and safety of Lidocaine 2% versus Dexamethasone injected locally in mastectomy wound as pain relieving agents. Materials & Methods: A randomized single-blinded study in which 50 patients candidate for Mastectomy were included. Participants were equally randomized into two groups; Group A, in which patients received 10 ml Lidocaine 2% and Group B, in which patients received 16 mL Dexamethasone. In both groups, the drugs were given via local infiltration in the subcutaneous layer of the Mastectomy wound immediately after skin closure. Pain control was assessed post-operatively in the first 24 hours using the visual analogue scale (VAS) in addition the need for additional analgesia was recorded. Results: There was a statistically significant lower VAS score in group A (Lidocaine group) when compared to those in group B (Dexamethasone group) 1 h, 6 h, 12 h postoperatively with no significance 24 h postoperatively (36% vs 64% 1 h, 28% vs 64% 6 h, 30% vs 72% 12 h and, 80% vs 60% 24 h). This statistical significance was evident throughout the post-operative hours (1 h, 6 h, 12 h). Though local Lidocaine caused marked improvement of pain in bigger number of patients in group A than group B, yet it showed no statistical significance 24 h post-mastectomy. Furthermore, the number of participants that needed additional doses of analgesia lower in group A (48% vs 56%) in comparison to group B, but still showed no statistical significance. Conclusion: Local injection of Lidocaine 2% in Mastectomy wounds, has an upper hand in reducing the post-operative pain and showed a lesser need for post-operative analgesia when compared to local Dexamethasone injection.

Effect of C-MAC Video Laryngoscope-aided intubations Using D-Blade on Incidence and Severity of Postoperative Sore Throat.

Background:Video laryngoscope-aided intubations require less force to align oral, pharyngeal, and laryngeal planes to visualize the glottis opening during intubation.Aim:The primary objective of the study was to assess the incidence and severity of postoperative sore throat (POST) in patients who were intubated with C-MAC video laryngoscope using D-blade versus traditional Macintosh laryngoscope.Settings and Design:This prospective, randomized, open label study was conducted in a tertiary care institution.Subjects and Methods:A total of 130 patients undergoing short elective laparoscopic surgeries lasting <2 h were recruited. All patients received general anesthesia as per a standardized protocol. Laryngoscopy was performed using traditional Macintosh laryngoscope in Group M and with Storz® C-MAC video laryngoscope using D-Blade in Group V. The endotracheal tube cuff pressure was maintained at 20–22 cm of H2O intraoperatively.Statistical Analysis Used:Pearson's Chi-square test, Fisher's exact test, and Independent sample t-test were used in this study.Results:As compared to Group M, number of patients who had POST, hoarseness of voice, and cough was significantly low in Group V at 2, 6, 12, and 24 h. Severity, as well as the incidence of all these symptoms, showed a downward trend in both groups with time. Significantly more number of patients in Group M required rescue therapy for POST (44.6% as compared to 7.7%, P < 0.001).Conclusion:C-MAC video laryngoscope-aided intubations using D-blade significantly reduced the incidence and severity of POST, hoarseness of voice, and cough following orotracheal intubation as compared to use of traditional Macintosh laryngoscope.

P355 The assessment of electrophysiological studies in patients with restless legs syndrome

Objectives To investigate the spinal excitability changes in patients with restless legs syndrome (RLS). Methods Five patients who were diagnosed as RLS clinically and free off the L-dopa treatment and 6 healthy controls (HC) were recruited. The symptom severity scale for RLS was evaluated. The electrophysiological studies consisted of F-wave studies, cutaneous silent period (CSP) recorded from extensor digitorum brevis (EDB) and abductor pollicis brevis (APB) muscles, H reflex studies recorded from soleus muscle. H reflex recruitment curves with double stimulation and H reflex during 50 Hz vibrations to Achilles tendon (Hv) were measured. Results The mean symptom severity scale was 17,4. The nerve excitability parameters, F-wave studies were not different between groups. The CSP were tended to be shorter in duration in EBD muscle in RLS patients (27 ms) than in HC (35,5 ms). The inhibition of H reflex during vibration reduced in RLS patients (Hv/Hmax%: 83,2 in RLS patients, 63,6 in HC). H reflex recruitment curves showed similar effect in inhibition and facilitation in both groups. Discussion The results of this study might reveal the increased excitability in spinal level in RLS patients. The findings in H reflex recruitment curves may be related with the small number of patients in groups. These studies displaying the spinal excitability changes would improve our understanding in pathophysiology in RLS.

Roux-en-Y hepaticojejunostomy versus hepaticoduodenostomy after excision of choledochal cyst: A randomized clinical trial and experience in a tertiary care hospital

Introduction: Excision of choledochal cyst is required to relieve biliary obstruction thereby protecting the liver and pancreas as well as to prevent malignancy in long term. But controversy persists in the two existing techniques of biliary reconstruction after cyst excision. Aim: To analyze the clinical presentation, incidence and types of choledochal cyst and our experience in management of these congenital anomalies. To compare the advantages and disadvantages between two modalities of biliary reconstruction. Methods: A prospective, controlled, clinical trial was conducted on patients with choledochal cyst in a tertiary care pediatric surgery hospital. They were divided into two groups; Group–A: Patients in whom biliary reconstruction was done by Roux-en-Y hepaticojejunostomy, Group-B: Biliary reconstruction done by Hepaticoduodenostomy. The two groups were compared in respect to clinical course, types of cyst, surgical difficulties with special emphasis on operating time, postoperative complications. Results: Choledochal cysts accounted for 0.79% of total admissions at our institute. Out of 31 admitted cases, 22 cases were enrolled in the study. The number of patients in group A were 10 and in group B were 12. Abdominal pain was the commonest presenting feature and Type I choledochal cyst was the most common finding. The average duration of surgery was less in group B (1 hour 25 min) than in group A (2 hours and 10 min). Conclusion: Biliary reconstruction by Hepaticoduodenostomy takes significantly less operative time than Roux-en-Y hepaticojejunostomy (P<0.05) and needs single anastomosis. It is more anatomical, physiological, easy to perform and associated with fewer complications.

Etiopathological differentiation of diabetes mellitus in lean, young adults

ObjectiveClassification of diabetes mellitus (DM) into type 1 or type 2 is difficult in lean, young individuals. We studied the β-cell function, insulin resistance (IR) and autoimmunity in young patients with recent onset DM. MethodsIn this cross-sectional study, we included patients (age below 35 years) with recent onset DM (<6 months) and normal body weight for evaluation. The detailed clinical examination was done to identify markers of IR. Autoimmune DM was diagnosed using glutamic acid decarboxylase 65 (GAD65), insulin autoantibody (IAA) and islet cell antibody (ICA). Homeostasis model assessment (HOMA) models of HOMA-B and HOMA- IR were used for estimation of β-cell function and IR respectively. The patients were divided into four groups based on, the autoimmunity (A) and ketosis (K) as group 1 (A+K), group 2 (A−K+), group 3 (A+K−) and group 4 (A−K−). Appropriate statistical tests +)were used to analyze the results. ResultsThe study population (n=75, all males) had a mean age of 28.9±4.3years, body mass index 20.6±1.9kg/m2, fasting plasma glucose 177.1±31.4mg/dl and HbA1c of 9.9±2.1% at presentation. The number of patients in groups 1 to 4 are 8, 5, 10 and 52 respectively (p<0.0001). HOMA-IR was higher in groups 2 and 4 (4.1±1.3, 3.6±1.1 respectively), whereas HOMA-B was higher in group 4 (3.6±1.5) alone (p=0.0005). ConclusionType 2 DM is the most common etiology even in young, lean adults in India. Further studies with large numbers are required to confirm our findings.

Relations of changes in serum carcinoembryonic antigen (CEA) levels before and after chemoradiotherapy (CRT) and after surgery to histological response and outcomes in patients with locally advanced rectal cancer (LARC).

804 Background: Multidisciplinary treatment had been a standard of care for locally advanced rectal cancer. Serum CEA had been reported as one of the predictive factors to CRT, however, serum CEA levels may change after CRT and surgery. We examined the relations of serum CEA before CRT, after CRT, and after surgery to histological response and outcomes. Methods: The subjects were 149 patients with cStage II or III adenocarcinoma of the rectum who underwent surgery after CRT from 2005 through 2013. A total dose of 40 to 45 Gy with concurrent oral UFT or S-1 was delivered. Surgery was performed 6 to 8 weeks after CRT. A serum CEA &gt; 5 ng/mL was defined as positive. Patients with negative serum CEA before CRT were designated as group 1. Patients with positive serum CEA before CRT that became negative after CRT were designated as group 2. Patients with positive serum CEA after CRT that became negative after surgery were designated as group 3, and patients with positive serum CEA after CRT as well as after surgery were designated as group 4. The median follow-up period of the survivors was 60.4 months. Results: The numbers of patients in Groups 1, 2, 3, and 4 were 55 (37%), 41 (28%), 37 (25%), and 16 (11%), respectively. The incidences of pCR, T downstaging, and N downstaging did not differ significantly among the groups (p = 0.094, 0.060, and 0.346). Rates of marked regression (TRG Grade 1 or 2) were 55% in Group 1, 42% in Group 2, 16% in Group 3, 25% in group 4. The rates were significantly higher in groups 1 and 2 (p = 0.001).5y DFS was 76% in group 1, 75% in group 2, 77% in group 3, and 48% in group 4 and was significantly lower in group 4 (p = 0.024). 5y OS was 88% in group 1, 91% in group 2, 85% in group 3, and 68% in group 4 and was significantly lower in group 4 than that in groups 1 and 2 (p = 0.03, 0.019). Conclusions: In patients with rectal cancer who received CRT, changes in serum CEA levels before and after CRT and after surgery were intimately related to the histological response of the primary lesion. Patients who continued to have positive serum CEA levels after surgery had poor outcomes, strongly suggesting the presence of occult distant metastasis.

Caudal Anaesthesia in Ambulatory Colonoscopy: Lidocaine Only vs. Lidocaine/fentanyl Combination

Background: This study aimed to compare the analgesic effects of caudal anaesthesia in patients undergoing ambulatory colonoscopy using lidocaine only or lidocaine/fentanyl combination. Methods: Fifty-one consecutive adult patients scheduled for colonoscopy participated in the study. Participants were randomly allocated into two equal groups (A and B). Caudal anaesthesia was instituted in both groups with 1.5% preservative free lidocaine (19.4 ml); 0.6 ml of normal saline was added in Group A and 30 mcg of fentanyl made to 0.6 ml in Group B. The time of onset and height of caudal block, Numeric Pain Rating Scale (NPRS) score at different stages during colonoscopy were evaluated and compared. The number of patients requiring rescue analgesia (fentanyl/midazolam) were also evaluated and compared. Results: Twenty-six patients in the saline-lidocaine group (A) and twenty-five patients in the fentanyl-lidocaine group (B) completed the study. The mean and standard deviation of the caudal block onset time (minute) in group A was 11.71 ± 4.26 comparable to group B which was 13.50 ± 4.85, p=0.15. The median NPRS while navigating the splenic flexure was 2 in group A and 3 in group B; and while navigating the hepatic flexure it was 5 in group A and 3 in group B. But p values are 0.285 and 0.031 respectively. Rescue analgesia was employed in fewer number of patients in group B (16%) compared to group A (34.6%). Conclusion: Caudal epidural block with lidocaine/fentanyl combination provided superior, safe and satisfactory anaesthesia for ambulatory colonoscopy.

Impact on Survival on Interval between Surgery and Adjuvant Chemotherapy in Completely Resected Stage IB-IIIA Lung Cancer.

Background and ObjectivesComplete surgical resection is recommended for early stage lung cancer, and adjuvant chemotherapy is given for stage IB to IIIA disease. No studies have examined the best timing to administer chemotherapy after surgery in lung cancer. This study was to investigate the optimal timing of adjuvant chemotherapy after surgical resection.MethodsData collected from the Taiwan National Health Insurance Research Database between January, 2004 and December, 2010 were retrospectively analyzed. Patients with stage IB to IIIA lung cancer underwent complete surgical resection and adjuvant chemotherapy were included. A total of 1522 patients were included. The patients were divided into 4 groups according to the interval between surgery and chemotherapy: group 1, < 30 days; group 2, 30–45 days; group 3, 46–60 days; group 4 > 60 days. Univariate and multivariate regression analyses were used to identify prognostic factors for overall survival.ResultsThe numbers of patients in groups 1, 2, 3, and 4 were 153, 161, 290, and 818, respectively. The 5-year survival rate was 41% in group 1, 48% in group 2, 50% in group 3, and 35% in group 4 (p<0.001). The median survival time was 44.50 months in group 1, 59.53 months in group 2, 67.33 months in group 3 and 36.33 months in group 4 (p<0.001) Survival rate is the poorest when chemotherapy is delayed beyond 60 days after surgical resection Multivariate analysis also indicated the interval between surgery and first course of chemotherapy more than 60 days after surgery was an independent risk factor for survival.ConclusionsTiming of chemotherapy after surgery is associated with poorer survival in lung cancer patients.

Effect of a mixture of diosmin, coumarin glycosides, and triterpenes on bleeding, thrombosis, and pain after stapled anopexy: a prospective, randomized, placebo-controlled clinical trial.

We evaluated the efficacy of oral administration of a mixture of diosmin, coumarin glycosides, and Centella asiatica (Venoplant®) in preventing bleeding, pain, and thrombosis of internal and external hemorrhoids after stapled anopexy (SA). SA was conducted in 182 patients with third-degree hemorrhoids. Preoperatively, patients were randomized evenly into two groups. Group A patients were administered Venoplant for 30days post-SA, and group B received a placebo for 30days post-SA. Patients received paracetamol for postoperative pain. Visit (v)1, v2, and v3 took place 7, 15, and 30days postoperatively, respectively; bleeding (clinical examination), visual analog scale (VAS), thrombosis (clinical examination), and pain (paracetamol dosage, VAS) were evaluated. At v1, v2, and v3, the numbers of patients with bleeding in groups A and B were 21 and 46, 3 and 25, and 1 and 5, respectively (p<0.05). At v1, v2, and v3, the numbers of patients in groups A and B with thrombosed internal hemorrhoids were 3 and 13, 2 and 11, and 1 and 8, respectively (p<0.05). The number of patients who took at least one paracetamol tablet was similar in both groups at v1 but was significantly greater in group B than group A at v2 and v3 (p<0.05); pain VAS scores were equivalent at v1 and significantly greater in group B than group A at v2 and v3 (p<0.05). Venoplant effectively reduced bleeding after SA, decreased the incidence of thrombosed internal hemorrhoids, and decreased postoperative pain.