Primary Location Research Articles

Endoscopic Submucosal Dissection for Recurrent Esophageal Squamous Cell Carcinoma Post-Radiation.

The feasibility and outcomes of salvage endoscopic submucosal dissection (ESD) and ESD for metachronous esophageal squamous cell cancer (ESCC) inside the irradiated field are not clear. To explore the viability of ESD for ESCC in areas previously exposed to radiation, identify elements hindering successful ESD, assess prognosis, and elucidate considerations for follow-up. Patients with ESCC who underwent salvage ESD or ESD for metachronous ESCC within the previously irradiated field at Kanagawa Cancer Center between January 1, 2013, and December 31, 2023, were retrospectively investigated to evaluate patient and lesion characteristics and short- and long-term outcomes. Thirty patients with 41 lesions were analyzed. The median age was 73 (52-88), and 93.3% were men. The middle thorax was the primary location, with flat lesions constituting 73.2%. In salvage ESD cases, the en bloc dissection rate was 91.3%, without adverse events. Conversely, the en bloc dissection rate in metachronous ESD was 100%, and aspiration pneumonitis and post-procedure stricture occurred in 12.5% and 12.5%, respectively. No lesion removed by salvage ESD recurred. During a median follow-up period of 685 (range 24-3061) days, 10 patients (52.6%) developed other organ malignancies, three died from pneumonia, and one died from pharyngeal cancer. The 5-year overall survival rate was 74.9%. No patient died of esophageal cancer. Salvage and metachronous ESD are feasible and can achieve high en bloc resection rates and good local control. Screening for other organ malignancies after salvage ESD is indispensable. Preventing aspiration may also improve the prognosis.

Histopathological Insights into Granulomatous Lesions: A Comprehensive Study

ABSTRACT Background: Granulomatous inflammation is a persistent inflammatory reaction marked by the presence of aggregations of active histiocytes, epithelioid cells, and multinucleate giant cells. This phenomenon is reported in several viral and non-infectious diseases and is classified as a type IV delayed hypersensitivity response. Research Materials and Procedures: The present cross-sectional study was conducted in the histopathology section of the Department of Pathology, MMIMSR, Mullana, from October 2022 to October 2023. A total of 100 cases presenting with granulomatous lesions were analyzed. Detailed clinical data, including age, sex, site of the lesion, and duration of disease, were recorded. Histopathological examination was performed using Hematoxylin and Eosin (H&E) stain, with additional special stains like Ziehl-Neelsen and Periodic Acid-Schiff (PAS) applied where necessary. Materials and Methods: This investigation was conducted at the histology division of the Department of Pathology, MMIMSR, Mullana, between October 2022 and October 2023. The analysis included a total of 100 patients that had granulomatous lesions. Precise clinical information, such as age, gender, location of the lesion, and length of illness, was documented. The histological analysis was conducted using hematoxylin and eosin (H and E) stain, along with supplementary specific stains, such as Ziehl-Neelsen and periodic acid-Schiff (PAS) when needed. Results: Lesions of granulomatous nature were more common in individuals in their third and fourth decades of life, with a little higher occurrence in females (male: female ratio = 1:1.43). The primary location of infection was the gastrointestinal system, accounting for 16% of cases, followed by the urogenital tract at 15% and soft tissues at 13%. Granulomatous pathology-not otherwise specified (GP-NOS) was the most prevalent histological category, representing 52% of cases. It was followed by granulomatous pathology-tubercular (GP-TB) at 15%, granulomatous pathology-leprosy (GP-L) at 3%, and one case of granulomatous pathology-fungal (GP-F). The etiology of 25% of cases was attributed to tuberculosis, whereas in 3% of instances, it was diagnosed as leprosy. The main kind of neoplasms seen were epithelioid cell granulomas, with caseous necrosis being the most prevalent form of necrosis. About 10% of patients had fibrosis, and Langhans giant cells were often documented. Conclusion: Histopathology, with the use of certain stains, continues to be the most reliable method for identifying and classifying granulomatous lesions. Despite the broad use of Bacillus Calmette-Guerin (BCG) vaccine, infections, including tuberculosis (TB), remain the primary cause of granulomatous lesions in our community.

Segmental versus extended colectomy for colorectal cancer in patients with lynch syndrome: A systematic review and meta-analysis.

The decision to perform segmental or extended colectomy in Lynch syndrome (LS) patients with colorectal cancer (CRC) is still controversial. Therefore, this systematic review and meta-analysis aims to provide updated evidence for segmental versus extended colectomy in LS carriers with CRC. PubMed, Embase, and Cochrane Library were systematically searched for studies published until January 2024 comparing segmental and extended colectomies for CRC in patients with LS. Risk ratio (RR) was used to evaluate binary endpoints with 95% confidence intervals (CIs). Heterogeneity was assessed with the Cochran's Q test and I2 statistics. Statistical analysis was performed using the R Software, version 4.2.3. A total of 14 studies comprising 2303 LS carriers with CRC, of whom 1724 (74.9%) patients underwent segmental colectomy and 579 (25.1%) patients underwent extended colectomy. Segmental colectomy significantly increased metachronous CRC (mCRC) (RR 2.87; 95% CI 2.03-4.07; and p<0.01). There were no significant differences between groups for 5-year overall survival (OS) (RR 0.92; 95% CI 0.82-1.03; and p=0.14), 10-year OS (RR 0.99; 95% CI 0.96-1.04; and p=0.80), and mortality (RR 1.63; 95% CI 0.90-2.97; and p=0.11). There were no significant linear associations between the outcome of mCRC and age at the time of primary CRC, sex, primary CRC location, and pathogenic LS variant. In this meta-analysis, segmental colectomy significantly increased mCRC compared with extended colectomy after the first surgery for CRC in patients with LS. However, there were no significant differences between groups for 5- and 10-year OS and mortality.

Clinicopathological Characteristics of Extranodal Marginal Zone Lymphoma of the Mucosa Associated Lymphoid Tissue (MALT-Lymphoma) of the Intestine: A Single Center Analysis.

Extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT-lymphoma) is an indolent B-cell lymphoma with a distinct affinity for mucosal structures. Most commonly arising in the stomach, only roughly 2% of MALT-lymphomas occur in the colon or the intestine. In view of this, we have retrospectively assessed all patients with MALT-lymphoma involving the intestine for clinicopathological characteristics. Data of all patients with MALT-lymphoma and intestinal involvement (i.e. both primary and secondary), treated and followed at the Medical University of Vienna between 1999 and 2021 were retrospectively collected from hospital records and analyzed. Differences in baseline and therapy characteristics, as well as survival between primary and secondary, and between intestinal and gastric MALT-lymphoma (as the most common subgroup of patients) were investigated. In total, 42 patients were identified; 24/484 (5%) were classified as primary and 18 (3.7%) as secondary intestinal MALT-lymphomas. The most common primary intestinal location was the colon (10/24) and the most frequent primary site in the 18 cases with secondary intestinal MALT-lymphomas was the stomach (14/18). A total of 28/42 (66.7%) patients presented with LUGANO stage I, 7/42 (16.7%) with stage II/IIE and 7/42 (16.7%) with stage IV disease. Translocation t (11; 18) (q21; q21) was positive in 47% of patients with secondary and 25% of primary intestinal MALT-lymphomas. Median OS in for intestinal MALT-lymphoma was 301months (95% CI n.a.) with 89.1% alive at 5years and 77.2% alive at 10years. Median PFS in the entire cohort was 50.4months (95% CI 38.4-62.4months), with an overall response rate and disease control rate of 73% and 97.3%, respectively. No difference in OS and PFS between primary and secondary intestinal, as well as between intestinal and gastric MALT-lymphoma was detected. Our data suggest that dissemination within the GI tract does not seem to be an adverse prognostic feature and highlights the preferred use of the Lugano staging system in such patients, which also summarizes multiple lesions within the GI-tract as Stage I.

Serum and urinary 5-hydroxyindolacetic acid, serotonin, chromogranin A, and NT-proBNP for the detection of carcinoid heart disease.

The aim of this study was to evaluate the performance of different biomarkers for the detection of carcinoid heart disease (CHD) in neuroendocrine tumours (NETs), in particular serum 5-HIAA (s5HIAA). An explorative ancillary study of the French CrusoeNET cohort. Patients managed in the Lyon-EURACAN Center of Excellence (CoE) were included when they were aged of at least 18 years, treated and followed for an advanced/metastatic ileum or lung NET, a NET irrespective of the primary location or from unknown primary location but with clinical CS, and/or elevation of urinary 5-HIAA (u5HIAA) twice greater than the upper limit of normal. All patients included had 1 available serum stored within the local biobank between January 2021 and April 2022. Echocardiography was performed by 1 of the 3 expert cardiologists of the Lyon-EURACAN-CoE. We included 138 patients with NETs, mainly of the small intestine and lung, and 19 of them had a CHD. Analysis showed that s5HIAA was well correlated with u5HIAA (ρ = 0.824 [0.76-0.88], P < .0001) and was a good biomarker for CHD detection (receiver operating characteristic curve = 0.85 [0.75-0.94], P < .0001). Using a threshold value of 757 nmol/L, the sensitivity and specificity for the detection of CHD were 84% and 80%, respectively. s5HIAA is highly sensitive and specific for CHD detection. It could be used as a pre-screening tool in centres where systematic and regular echocardiography by an expert cardiologist is not performed in this population.

Prevalence and determinants of smoke-free homes in 12 European countries: the TackSHS Survey

BackgroundHomes are one of the primary locations where people are exposed to second-hand smoke (SHS) in Europe. We describe the prevalence and identify the main determinants of having home-smoking restrictions in 12 European countries.MethodsCross-sectional survey in 12 European countries conducted in 2017–2018 (TackSHS Project). Approximately 1000 participants representing the general population aged ≥15 years of each country were interviewed face-to-face. Individual and country-level characteristics were explored through adjusted prevalence ratios (PR) obtained from multilevel Poisson models with random effects.ResultsAmong 11 734 participants, 70.2% (95%CI: 69.4–71.0%) had smoke-free homes and 17.5% (95%CI: 16.8–18.2%) had partial home-smoking restrictions in place. Prevalence of smoke-free homes ranged from 44.4% in Greece to 84.5% in England. Having a smoke-free home was significantly inversely associated with current (PR=0.60) or former (PR=0.95) smoking and living in a household with one (PR=0.70) and two or more (PR=0.58) people who smoke. It was also significantly associated with being ≥65 years old (PR=1.05), being female (PR=1.07), having a high educational level (PR=1.09), and living with children (PR=1.09). Having a smoke-free home was associated with living in Northern Europe, while partial home-smoking restrictions were more likely among respondents from Eastern Europe and countries with lower per capita gross domestic product.ConclusionsThe prevalence of smoke-free homes in Europe is relatively high, but with large variability across countries. European countries with a lower prevalence of smoke-free homes should implement tailored interventions targeting identified determinants and incorporate the success of other countries.

Mobility changes following COVID-19 stay-at-home policies varied by socioeconomic measures: An observational study in Ontario, Canada.

In Canada, lower income households and essential workers were disproportionately at risk of SARS-CoV-2. Early in the pandemic, stay-at-home restriction policies were used to limit virus transmission. There remains an evidence gap in how changes in mobility, in response to the policies, varied across socioeconomic measures in Canada. The study objective was to describe the variability in mobility change to two restrictions, by neighborhood-level income and by proportion essential workers across five regions in Ontario, Canada. The first restriction was implemented on March 17, 2020 in all five regions; and the second restriction was implemented in November 23, 2020 in two of the regions. Using cell-phone mobility data aggregated to the census tract, we compared the average mobility (% of devices that travelled outside their "primary location") three weeks before and after each restriction. We defined the adjusted mobility change via pre-restriction mobility subtracted from post-restriction, adjusted for 2019 levels. We used difference-in-differences analysis to quantify effect modification of the second restriction's effect by socioeconomic measures. With the first restriction, crude mobility fell from 77.7% to 41.6% across the five regions. The adjusted mobility change to the first restriction was largest in the highest-income neighborhoods (-43.3% versus -38.4%) and in neighborhoods with the fewest essential workers (-44.5% versus -37.6%). The overall adjusted mobility change to the second restriction was small: -0.96% (95% confidence intervals, -1.53 to -0.38%). However, there was evidence of effect modification by socioeconomic measures (less pronounced decrease in lower-income neighborhoods and more essential workers). The findings suggest a temporal saturation effect of restrictions over subsequent waves, and a saturation effect by income and occupation, leading to prevention gaps across populations by socioeconomic measures. Findings highlight the need for tailored approaches at the intersections of income and occupation when addressing epidemics of novel and resurging respiratory pathogens.

Primary liver yolk sac tumor with lung metastasis in adolescence: Rare case report

Introduction: Germ cell tumors (GCTs) often arise within the gonads but occasionally appear within the extragonadal areas. Yolk sac tumors (YSTs), a type of GCT, are most often found in infants and adolescents due to puberty. However, primary liver YST cases are rare, with only one other reported case in the adolescent population. Case Report: The current case examines a 15-year-old female patient experiencing significant weight loss, respiratory issues, and fevers. After her blood work displayed high alpha-fetoprotein (AFP) levels, a biopsy revealed a stage four primary liver YST with lung metastasis. The infrequency and primary location of the tumor, combined with her age, create challenges in diagnosis and treatment. Due to its rarity, the reporting of this case may aid in diagnosis when encountered. We highlight and present our experience of management and prognosis of primary-hepatic YST when encountered in adolescents. Conclusion: At two years follow-up, the patient showed no evidence of recurrence or metastasis.

Is it Time to Adopt a New Nomenclature and Classification for White Dot Syndromes Using Multimodal Imaging Techniques? Report 1 from Multimodal Imaging in Uveitis (MUV) Task Force

ABSTRACT Purpose The survey aims to explore the use of existing nomenclature and current clinical and multimodal imaging (MMI) approach in diagnosing white dot syndromes (WDS) among uveitis and retina specialists. Methods The members of the International Uveitis Study Group (IUSG) task force MUV (Multimodal imaging in UVeitis) developed a survey. The questionnaire, created using Qualtrics, consisted of 22 questions. The responses were compared against regions, workplace setting, sub-specialty, and experience of the participants. Results A total of 432 participants initiated the background section; 343 initiated the investigation section and 263/343 completed the survey (76.7%). The majority (43.7%) reported a specialty/practice focus mostly on uveitis, 32.2% on uveitis and retina, and 20.1% mostly on retina. Specifically, 55.7% were in practice > 10 years post-fellowship and 65.8% worked in academic settings. The term WDS was not universally used in clinical practice, with no significant differences by region, subspecialty, experience, workplace setting or number of WDS patients managed in the prior year (p > 0.01). Nearly 90% of participants reported using MMI to diagnose WDS. More than 70% advocated redefining the nomenclature and classification of WDS based on the primary anatomical location of disease using MMI without significant regional or professional differences (p > 0.01). Conclusion These results underscore the widespread adoption of MMI among uveitis and retina specialists in the characterization of entities traditionally grouped under the term WDS. Respondents strongly agree that MMI provides a precise distinction between these posterior uveitis, advocating for the overcoming of the clinical term WDS in favor of a patho-anatomic redefinition.

Risk assessment of uranium in water sources near coal mines and in human organs of Shahdol District, Madhya Pradesh, using biokinetic modelling.

This study concentrated on determining the levels of uranium present in drinking water samples obtained from various locations throughout the Shahdol district in Madhya Pradesh, India. In this assessment a LED fluorimeter Quantalase (LF-2a) was utilized. Uranium, being a radioactive substance, can be hazardous to health when consumed in significant quantities over extended durations. The study found that the average uranium concentration was 167.91µg/L. 82% of samples exceeded recommended limits, emphasizing the essential aspect of this study. The study utilizes the age-specific biokinetic model developed by the International Commission on Radiological Protection to examine uranium distribution across various organs. Using dosimetric model, the study provides a comprehensive health risk analysis by assessing the chemical toxicity and the radiation dosages received by particular organs. Longitudinal studies on uranium distribution across different organs and tissues showed that the kidneys, liver, non-exchangeable bone volume, and soft tissues are the primary locations where uranium accumulates.

Abstract PR014: PVT1 fusion on extrachromosomal DNA (ecDNA) increases oncogene RNA stability and cancer cell growth

Abstract Extrachromosomal DNA (ecDNA), highly amplified circular DNA, is widespread in human cancers and serves as a primary location for oncogene amplification. Due to its dynamic structural rearrangement and asymmetric inheritance during cell division, ecDNA increases tumor genome complexity, contributing to drug resistance and shortened patient survival. Here, we show that ecDNA-mediated genomic amplification is highly associated with transcript fusion events, which are prevalent in cancer and often lead to tumor development. We discovered that transcripts with the highest fusion events originate from genes amplified on ecDNA across ecDNA(+) cell lines. Notably, PVT1 (Plasmacytoma Variant Translocation 1) long noncoding RNA, which is known to be a hotspot for chromosomal translocation, is the most frequently fused RNA species in MYC/PVT1-amplified ecDNA(+) cancer cells. Exon 1 of PVT1 is the predominant fusion partner and confers RNA stability, increasing the RNA abundance of the partner oncogene. Using a model cell line with PVT1-MYC fusion on ecDNA, we found that RNA expression of PVT1-MYC increases in vivo in an ecDNA-dependent manner, while canonical MYC does not show a prominent increase. Additionally, ectopic expression of PVT1- MYC in MYC-depleted cancer cells provides higher rescue efficiency than canonical MYC. In contrast, a PVT1-MYC mutant that is unable to enhance RNA stability fails to rescue, highlighting the functional significance of PVT1-mediated RNA stabilization in cancer. This study unveils the link between PVT1 fusion and ecDNA in cancer, providing insights for developing diagnostic and therapeutic approaches tailored to target ecDNA. Citation Format: Hyerim Yi, Shu Zhang, Matthew G Jones, Julia A Belk, Jason Swinderman, Quanming Shi, Ellis J Curtis, Vishnu P Kanakaveti, Paul S Mischel, Howard Y Chang. PVT1 fusion on extrachromosomal DNA (ecDNA) increases oncogene RNA stability and cancer cell growth [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: RNAs as Drivers, Targets, and Therapeutics in Cancer; 2024 Nov 14-17; Bellevue, Washington. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(11_Suppl):Abstract nr PR014.

Anatomical investigation of the venous system in pedicled nasal septal mucosal flap and its application in nasal skull base reconstruction

Objective: To investigate the distribution and primary drainage sites of the venous drainage system in the pedicled nasal septal mucosal flap, as well as to examine protective measures for the venous system of the nasal septal mucosal flap and its application in repairing the nasal skull base through the anatomical study of the nasal septum mucosal venous system in cadavers. Methods: Gross anatomy dissections were performed on 13 sides perfused fresh frozen cadaveric head specimens. The nasal septum mucosal flap was separated along the perichondrium and subperiosteum, then passed across the vomer, anterior wall of sphenoid sinus, clivus, and towards the anterior edge of vertical plate of palatine bone. Detailed documentation, including photographs, was made to record the morphology, distribution and drainage location of veins of the nasal septum mucosal flap and its pedicle, along with number of sphenopalatine veins. Furthermore, venous injuries resulting from obtaining a pedicled nasal septal mucosa flap were observed. From March 2023 to March 2024, a retrospective analysis was conducted on patients with nasopharyngeal lesions who underwent surgical repair using a modified pedicled nasal septum mucosal flap for venous system protection in the ENT institute and Department of Otorhinolaryngology at the Eye & ENT Hospital of Fudan University. The postoperative endoscopy was employed to assess the viability of the mucosal flap. Results: The veins of the nasal septum mucosa were primarily located in the posterior region, including the vomerine region, anterior wall of the sphenoid sinus, clivus region, and posterolateral wall of the nasal cavity, in a reticular pattern. Perforating veins draining into these bony structures could be observed, although their quantity and morphology varied. Notably, no prominent sphenopalatine veins were identified in 10 specimens examined, while 3 specimens exhibited sphenopalatine veins: one with a small single branch and two with venous bundles. Preservation of the nasal septal vein was possible when dissection was limited to the anterior edge of the wing of vomer. A wider range of dissection increased the risk of veinous injury. In cases where only vascular pedicles at the sphenopalatine foramen were preserved, three cadaveric head specimens retained intact sphenopalatine veins, while drainage veins were completely destroyed in ten other specimens. Fifteen patients with unilateral lesions (8 with recurrent nasopharyngeal carcinoma and 7 with nasopharyngeal radionecrosis) were included in this study. The postoperative reconstructions were carried out using contralateral pedicled nasal septal mucosal flaps. The average follow-up time was 7 months (ranging from 3 to 12 months), and all the nasal septal mucosal flaps survived. Conclusions: The primary location of the drainage vein within the nasal septum mucosa is situated in its posterior region, where it penetrates into adjacent bone structures. Very few sphenopalatine veins pass through the sphenopalatine foramen. Extensive dissection of the pedicled nasal septal mucosal flap may potentially impair the venous system and adversely affect flap survival rates, necessitating further clinical exploration.

Disparities in Patient Portal Activation and Usage at a Large Pediatric Academic Institution.

Access to personal medical information promotes patient understanding of health issues and enables patient self-advocacy of healthcare needs. The advent of electronic medical record systems and the 2016 21st Century CURES Act promoted and encouraged patient access to personal medical information, yet technology-dependent modalities have often disadvantaged certain communities. We sought to evaluate whether disparities existed in access to patient portals at our institution, the main pediatric care provider in an area serving one million children. We evaluated the activation of patient portal accounts at our institution over the past decade (2010-2021). Portal activation data were analyzed by ethnic background and language preference and income information available based on primary home access location. Further, we evaluated portal activation rates over time and across institutional interventions. A logistic regression model was used to identify important demographic associations with portal account status. Over 1 million patients were served at our pediatric institution over the study period with 47.7% having ever activated their patient portals. Univariate analyses and ultimately logistic regression modeling demonstrated significant differences in portal activation by ethnicity (odds ratio (confidence interval):1.36 (1.34, 1.37)), language preference (1.39 (1.37, 1.40)), and median household income (1.00001 (1.00001, 1.00001)). Interim interventions were successful in improving portal activation rates. Overall, electronic medical record portal activation was less prevalent among Hispanic, non-English speakers, and patients living in communities with lower median household income. Opportunities for interventions exist to reduce healthcare disparities in these underserved communities.

Risk of second primary cancers in nodal non-Hodgkin lymphoma patients by primary lymph node location: a retrospective cohort population-based study.

Non-Hodgkin lymphoma (NHL) is a diverse group of blood cancers with increasing incidence and survival rates due to advancements in treatment and early detection. However, NHL survivors are at significant risk of developing second primary cancers, which can adversely impact their long-term survival. This retrospective population-based cohort study utilized data from the Surveillance, Epidemiology, and End Results database, covering 17 geographic areas in the United States from 2000 to 2021. The authors included patients diagnosed with nodal NHL as a first primary cancer and excluded those diagnosed at autopsy or via death certificate only. Standardized Incidence Ratios, Absolute Excess Risks, and Person-Years at Risk were calculated to evaluate the risk of developing SPCs according to the primary lymph node site and stratified by latency periods following the initial NHL diagnosis. The cohort included 54012 NHL patients. The authors' results showed that for most SPCs, the risk of development was different for different primary NHL lymph node locations. The highest risks were observed for thyroid cancer, acute myeloid leukemia, and Hodgkin lymphoma. Notably, the risk for thyroid cancer was highest in the first year post-diagnosis, while hematological malignancies such as acute myeloid leukemia and Hodgkin lymphoma showed elevated risks in the intermediate and late latency periods. NHL survivors are at an increased risk of developing SPCs, influenced by the primary lymph node site and latency period. These findings highlight the need for tailored surveillance strategies and preventive measures to mitigate the long-term risks of SPCs in NHL survivors. Further research is necessary to elucidate the underlying mechanisms and to develop targeted interventions for this high-risk population.

Bibliometric Analysis of Risk Factors Contributing to Maternal Mortality: Trends and Research Directions

ABSTRACT Maternal mortality remains a significant global health challenge, with high maternal mortality rates in many parts of the world being a key indicator of disparities in maternal health care. While great efforts have been made to reduce these mortality rates, the various contributing risk factors remain a major focus of efforts. This study aimed to conduct a bibliometric analysis of the scientific literature addressing risk factors contributing to maternal mortality over the period 2017 to 2024. In this study, data was obtained from 50 relevant articles retrieved from Google Scholar using Publish or Perish software. The articles were filtered based on relevance and analyzed in depth. The data collected included information on publication year, country of origin, publisher, number of citations, and article type. To generate a comprehensive bibliometric map, VOSviewer was used with the parameters of occurrence of at least 4 and 19 terms, as well as network visualization, overlay, and density. The analysis showed that research on maternal mortality has consistently focused on various risk factors and aspects of maternal health, with a significant emphasis on factors related to pregnancy complications, postnatal care, and socioeconomic health conditions. Developed countries such as the United States are often the primary location of research, indicating a high concentration of studies in these countries. In addition, the research highlighted consistent attention to the importance of adequate health care and specific health issues faced by pregnant women. The analysis also revealed that key themes in the current literature include the management of postpartum hemorrhage, postpartum infections, and the influence of socio-economic factors on maternal health. This study provides valuable insights into current research directions and trends in maternal health and underscores the importance of continuing to identify and mitigate risk factors that contribute to maternal mortality. The findings are expected to guide the development of more effective interventions and health policy strategies that can reduce maternal mortality globally and improve maternal health outcomes worldwide. Keywords: Maternal Mortality, Risk Factors, Bibliometric Analysis, Healthcare Interventions, Research Trends

Left Atrial Appendage Occlusion During Cardiac Surgery to Prevent Stroke: A Systematic Review and Meta-Analysis

BackgroundAtrial fibrillation accounts for one-sixth of all strokes, potentially leading to significant disability and death. The left atrial appendage (LAA) is the primary location for thrombus formation. Excluding the LAA has been hypothesized to decrease the risk of ischemic stroke. ObjectivesThis study examines LAA occlusion (LAAO) with otherwise indicated cardiac surgery and its effect on surgical outcomes. MethodsWe followed the standards recommended by the Cochrane Collaborative Group and PRISMA checklist to prepare this systematic review and meta-analysis. Studies were retrieved through an online bibliographic search, studies were screened, and data were extracted. We compared the two study arms (LAAO and cardiac surgery without LAAO). Ten studies have been included in this study, and six Randomized Controlled Trials (RCTs) were included in the meta-analysis, with data pooled from over 10,000 patients. ResultsLAAO is associated with no significant difference in the overall mortality (p=0.98) and systemic embolism (p=0.31). Strokes and ischemic strokes, in particular, have significantly lower risk in patients who underwent LAAO (p< 0.0001 and p =0.0007), respectively. ConclusionLAAO can be done safely as a concomitant surgery with other cardiac surgeries with a minimal incremental cost when performed concurrently. LAAO is associated with a lower risk of all stroke and ischemic strokes. Further studies are needed to shape guidance on the continuation versus discontinuation of anticoagulation after LAAO, especially in patient populations with a higher risk of bleeding.

Hsa_circ_0001492 regulates the hsa-miR-145-5p/ovarian carcinoma immunoreactive antigen domain 2 axis to promote the progression of lung adenocarcinoma.

Circular RNA (circRNA) has been proven to be a key regulator in a range of tumor illnesses, such as lung adenocarcinoma (LUAD); however, the regulatory mechanisms of circRNA remain unclear. In this study, circRNA (hsa_circ_0001492) in LUAD was examined for its regulatory and functional potential. qRT-PCR was used to assess the hsa_circ_0001492 level in LUAD. The RNAse R digestion test was employed to isolate hsa_circ_0001492. The primary location of hsa_circ_0001492 enrichment in LUAD cells was identified through a nucleoplasmic separation test. LUAD cell migration, proliferation, and spherogenicity were examined using wound healing, transwell, EdU, and cell spherogenicity assays. The association between miR-145-5p and hsa_circ_0001492/ovarian carcinoma immunoreactive antigen domain 2 (OCIAD2) was validated using a dual luciferase experiment. The interaction between sh-hsa_circ_0001492 and miR-145-5p was confirmed through an RNA pull-down assay. The effects of hsa_circ_0001492, miR-145-5p, and OCIAD2 on LUAD tumor development were examined using xenograft mouse models and immunohistochemistry tests. Results showed a higher amount of hsa_circ_0001492 in LUAD. The cytoplasm of LUAD cells was observed in the area where hsa_circ_0001492 mainly accumulated; hsa_circ_0001492 enhanced LUAD cell migration, proliferation, and sphere-forming ability. MiR-145-5p and OCIAD2 were identified as targets of hsa_circ_0001492 and miR-145-5p, respectively. The level of OCIAD2 was increased by hsa_circ_0001492 through targeted binding to miR-145-5p. In nude mice, tumor growth was inhibited by silencing hsa_circ_0001492, while knockdown of miR-145-5p and overexpression of OCIAD2 promoted the growth of LUAD tumors. In conclusion, hsa_circ_0001492 regulates the hsa-miR-145-5p/OCIAD2 axis to promote the progression of LUAD, and could be a useful target for the diagnosis and treatment of LUAD.

Increasing Follow-up for Adolescents With Depressive Symptoms.

Prompt follow-up for positive depression screen results is important in providing high-quality care for adolescents. We sought to improve follow-up within 30 days for adolescents (≥12 years) with Patient Health Questionnaire-9 scores ≥10, or those with a positive question 9, from 25% to 40%. We conducted a quality improvement project at 6 primary care locations serving ∼33,300 patients (70% Black, 7.3% Hispanic, 80% Medicaid-enrolled). Our team identified key drivers and iteratively tested interventions, including contacting patients after antidepressant medication initiation, scheduling patients for follow-up during index visits, collaborating with integrated psychologists to expedite therapy for higher-risk patients, and reaching out to patients without scheduled follow-ups. Pre-intervention, 13.3% (589 of 4427) of adolescent encounters met the criteria for follow-up within 30 days, and 25.8% had a documented follow-up within 30 days. During the intervention period, 12.3% (764 of 6224) of adolescent encounters met the criteria for follow-up within 30 days, and the mean follow-up rate increased to 43.1%. By monitoring process measures, we scheduled follow-up visits for 18.9% of patients during the index encounter. Outreach to the remainder led to 32.6% of these patients completing follow-up. Our balancing measure of monitoring integrated psychology visit volumes remained stable. The application of quality improvement methods in primary care practices increased the frequency of follow-up care for high-risk adolescents after a positive depression screen.

Safety and risk analysis of total resection surgery for thoracic and lumbar spinal tumors: a decadal analysis of 103 cases

Study designRetrospective cohort study.PurposeTo explore the complications and risk factors for total resection (TR) of primary thoracic and lumbar spinal tumors over the past decade at our institution.MethodsPatients meeting inclusion criteria (primary spinal tumors, thoracic or lumbar location, TR at our center) were included. Demographic characteristics, surgical data, perioperative complications and management results were reviewed. Patients were stratified by tumor site, the number of excised segments, and recurrence status to elucidate distinctive characteristics.ResultsThe cohort comprised 103 patients, with a mean age of 35.8 years. On average, 1.83 vertebral segments were resected per patient. Perioperative complications were substantial, totaling 166 events, with 71 classified as major and 95 as minor, yielding an average of 1.61 complications per patient. No perioperative deaths occurred, but 79 patients (76.7%) experienced at least one complication. Multiple vertebral sections correlated with a higher complication rate (P = 0.031), and lumbar surgeries exhibited elevated risks of large vascular injury (P = 0.001), neurological deterioration, and cerebrospinal fluid leakage compared to thoracic cases. Conversely, thoracic spinal procedures showed a higher rate of pleural effusion (P = 0.004). Binary logistics stepwise regression identified multi-segmental resection as the independent risk factor for major perioperative complications.ConclusionsTR of primary spinal tumors is associated with a high perioperative complication rate, although most events have a favorable prognosis. Complication characteristics vary based on the surgical site, number of excised segments, and surgical history. A nuanced preoperative evaluating approach considering patient age, surgical segments, and extent of resection is crucial.

The Utility of Multitarget Stool DNA Testing for Colorectal Cancer Screening After a Normal Colonoscopy.

Multitarget stool DNA (MT-sDNA) tests (here, Cologuard®) are currently used in average-risk patients as a primary method of screening for colorectal cancer. However, MT-sDNA testing has also been used in patients who previously underwent colonoscopy who wish to avoid repeat colonoscopy. Here, in a large primary care practice setting, our aim was to evaluate the diagnostic performance of MT-sDNA testing in patients with a previously normal colonoscopy. This retrospective cohort study included 5827 patients from 35 different primary locations in South Carolina. Patients aged 45 and above with a previously documented normal, high-quality colonoscopy prior to the MT-sDNA test date were included. High-risk patients and those with a previous negative MT-sDNA result were excluded. Of 5827 ordered MT-sDNA tests, 248 patients had a prior normal colonoscopy. The average time from initial colonoscopy to MT-sDNA testing was 7.3years. Of the 63 patients who had a positive MT-sDNA test, 41 patients (65%) completed follow-up colonoscopy and 40 patients had complete colonoscopy data. Of these 40 patients, 12 patients (30%) had advanced adenomas and none had colorectal cancer. Compared to patients without a previous colonoscopy, patients with prior colonoscopies had fewer adenomas of all types (1.6 vs 2.4) and fewer advanced adenomas (1.4 vs 2.0). Patients with a previously negative colonoscopy and subsequent positive MT-sDNA test were found to have a high rate of advanced adenomas on follow-up colonoscopy (30%). Thus, in patients with a previously negative colonoscopy, MT-sDNA testing may be a reasonable alternative screening option.