Patient Selection Research Articles

Ethical frontiers in liver transplantation

Liver transplantation represents a pivotal intervention in the management of end-stage liver disease, offering a lifeline to countless patients. Despite significant strides in surgical techniques and organ procurement, ethical dilemmas and debates continue to underscore this life-saving procedure. Navigating the ethical terrain surrounding this complex procedure is hence paramount. Dissecting the nuances of ethical principles of justice, autonomy and beneficence that underpin transplant protocols worldwide, we explore the modern challenges that plaques the world of liver transplantation. We investigate the ethical dimensions of organ transplantation, focusing on allocation, emerging technologies, and decision-making processes. PubMed, Scopus, Web of Science, Embase and Central were searched from database inception to February 29, 2024 using the following keywords: “liver transplant”, “transplantation”, “liver donation”, “liver recipient”, “organ donation” and “ethics”. Information from relevant articles surrounding ethical discussions in the realm of liver transplantation, especially with regards to organ recipients and allocation, organ donation, transplant tourism, new age technologies and developments, were extracted. From the definition of death to the long term follow up of organ recipients, liver transplantation has many ethical quandaries. With new transplant techniques, societal acceptance and perceptions also play a pivotal role. Cultural, religious and regional factors including but not limited to beliefs, wealth and accessibility are extremely influential in public attitudes towards donation, xenotransplantation, stem cell research, and adopting artificial intelligence. Understanding and addressing these perspectives whilst upholding bioethical principles is essential to ensure just distribution and fair allocation of resources. Robust regulatory oversight for ethical sourcing of organs, ensuring good patient selection and transplant techniques, and high-quality long-term surveillance to mitigate risks is essential. Efforts to promote equitable access to transplantation as well as prioritizing patients with true needs are essential to address disparities. In conclusion, liver transplantation is often the beacon of hope for individuals suffering from end-stage liver disease and improves quality of life. The ethics related to transplantation are complex and multifaceted, considering not just the donor and the recipient, but also the society as a whole.

Selective nonoperative management of abdominal gunshot wounds: What you need to know.

Since the 1990s, there has been a slow but steady adoption of selective nonoperative management (SNOM) for abdominal gunshot wounds (GSW). Multiple studies have shown that SNOM is feasible and can be performed safely, even at trauma centers with low penetrating trauma volumes. The principles of SNOM for abdominal GSW consists of (1) careful patient selection, (2) diagnostic workup with CT, and (3) clinical observation. By implementing SNOM, the number of patients undergoing a nontherapeutic laparotomy can significantly be improved to less than 10%. Overall, approximately one third of patients with abdominal GSW can be managed nonoperatively. This review article provides a practical approach to the management of patients with an abdominal GSW.

Microwave-Energy-Based Device for the Treatment of Cellulite and Localized Adiposity: Recommendations of the “Onda Coolwaves” International Advisory Board

The body contour market has grown rapidly in recent years, due to persistent requests for noninvasive treatments for localized fat adiposities, cellulite, and skin laxity. A variety of different methods are now available to improve body shaping. This review aims to provide an exhaustive compendium of the main recommendations for the optimal use of an innovative device delivering microwaves (MWs) for unwanted fat and cellulite reduction (Onda Coolwaves, DEKA, Florence, Italy), resulting from the experiences of the most expert international users. The availability of this new technology has led to an increasing number of treated patients and clinical studies. However, what is still missing, to the best of our knowledge, is an evaluation of the long-term efficacy and safety of this method. Based on the most recent data available, this compendium focuses on the ideal parameters, patient selection, and treatment methodology for providing safe and effective treatment protocols. Future research findings may suggest changes to the conclusions or recommendations in this report.

Plasma cell-free DNA chromatin immunoprecipitation profiling depicts phenotypic and clinical heterogeneity in advanced prostate cancer.

Cell phenotype underlies prostate cancer presentation and treatment resistance and can be regulated by epigenomic features. However, the osteotropic tendency of prostate cancer limits access to metastatic tissue, meaning most prior insights into prostate cancer chromatin biology are from preclinical models that do not fully represent disease complexity. Noninvasive chromatin immunoprecipitation of histones in plasma cell-free in humans may enable capture of disparate prostate cancer phenotypes. Here, we analyzed activating promoter- and enhancer-associated H3K4me2 from cfDNA in metastatic prostate cancer enriched for divergent patterns of metastasis and diverse clinical presentation. H3K4me2 density across prostate cancer genes, accessible chromatin, and lineage-defining transcription factor binding sites correlated strongly with circulating tumor DNA (ctDNA) fraction-demonstrating capture of prostate cancer-specific biology and informing the development of a statistical framework to adjust for ctDNA fraction. Chromatin hallmarks mirrored synchronously measured clinico-genomic features: bone versus liver-predominant disease, serum PSA, biopsy-confirmed histopathological subtype, and RB1 deletions convergently indicated phenotype segregation along an axis of differential androgen receptor activity and neuroendocrine identity. Detection of lineage switching after sequential progression on systemic therapy in select patients indicates potential utility for individualized resistance monitoring. Epigenomic footprints of metastasis-induced normal tissue destruction were evident in bulk cfDNA from two patients. Finally, a public epigenomic resource was generated using a distinct chromatin marker that has not been widely investigated in prostate cancer. These results provide insight into the adaptive molecular landscape of aggressive prostate cancer and endorse plasma cfDNA chromatin profiling as a biomarker source and biological discovery tool.

SUBCLINICAL SEIZURES ON EEG WITH SLEEP PHASES AND CLINICAL SIGNIFICANCE IN PATIENTS WITH FOCAL EPILEPSY

Purpose: It is observed in studies that subclinical seizures have significant impact on the diagnosis, prognosis, and treatment responses. Aim of our study is investigating presence of these seizures, their relationship with sleep, contribution to diagnosis, and impact on treatment selection and prognosis in patients diagnosed with focal epilepsy. Materials and methods: Total of 1,626 EEGs conducted in the EEG unit were examined. Among them, 626 were found to belong to patients diagnosed with focal epilepsy. 140 patients who underwent twenty-minute EEG monitoring and 28 patients who underwent twenty-four-hour EEG monitoring were included in the study. Results: A comparative analysis was conducted between two cohorts of patients: one subjected to a twenty-minute EEG and the other undergoing a 24-hour EEG. In the presence of resistant epilepsy, the risk of SCS is increased by 3.1 times. The presence of SCS in frontal lobe epilepsies demonstrated a 2.2-fold elevation compared to temporal lobe epilepsies (1.0-5.3). A statistically significant relationship between Levetiracetam usage and seizures was observed (p=0.044). The calculated Odds Ratio for risk indicated a 1.2-fold (1-1.6) higher frequency of seizures with Levetiracetam usage. Risk analysis revealed a 1.5-fold (1.2-1.9) higher incidence of seizures with the use of well-known drugs in favor of lacozamide-zonisamide. Conclusion: SCSs are gaining increasing clinical significance in terms of diagnosis, prognosis, and treatment. The relationship between these sleep and SCSs holds importance for future research with a larger number of patients and centers.

Utilizing Auricular Composite Grafts for Reconstruction of Nasal Ala Defects in Fitzpatrick Type III-V Indian Noses: Techniques and Outcomes.

Nasal ala defects present significant reconstructive challenges due to their complex anatomy and functional importance. Auricular composite grafts, incorporating both skin and cartilage, are particularly suited for this purpose because they can replace the multilayered structure of the nasal ala in a single surgical procedure, thereby restoring both form and function. Clinical outcomes of these grafts in the reconstruction of ala defects have been highly promising with studies indicating near complete survival rates. These findings underscore the efficacy of composite grafts in achieving successful results in these small but difficult defects to manage. The primary objective of this study is to assess the use of composite graft in Fitzpatrick type III-V Indian noses from survival and esthetic point of view. A retrospective review was conducted on eleven patients who underwent nasal ala reconstruction using auricular composite grafts between 2012 and 2022. Data collected included patient demographics, defect etiology and characteristics, surgical technique, postoperative outcomes and complications and follow-up duration. A total of eleven patients, age ranged from 17 to 68years, were included in the study. The majority of defects (seven) were acquired and resulted from trauma, ring avulsion and tumor excision and four were congenital clefts of ala. Graft survival rate was more than 90% with a follow-up period of 6months to 2years. Out of eleven grafts, one shrank approximately to half. No other complication was noted. Rest ten graft survived well with minimal shrinkage and produced esthetically pleasing and good functional outcome. Auricular composite grafts are a reliable and effective option for nasal ala reconstruction. The technique demonstrates a favorable balance between functional restoration and cosmetic appearance, with an acceptable complication rate. Careful selection of patients, suitable conditions and an additional vascular bed provided by turndown flap of lining allow a better survival of not only of standard size grafts but even slightly bigger grafts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Pediatric gastrostomy tube referral patterns and postoperative use: A single-center experience.

Practice variability exists regarding the timing of gastrostomy tube (GT) placement in patients unable to maintain adequate oral nutrition. We sought to assess patient factors predictive of longer surgical GT use to inform patient selection. We conducted a single-center, retrospective cohort study including children ≤18 years who underwent surgical GT placement from June 1, 2018 to June 1, 2021 at a children's hospital. Bivariate and logistic regression analyses were performed to assess the impact of referral patterns, operative indications, and patient comorbidities on the length of GT use. Four hundred fifty-eight children underwent GT placement. Median age at placement was 5 months (interquartile range [IQR]: 2-12) and 52% were male. Fifty-six percent were referred from a neonatal intensive care unit;/cardiovascular intensive care unit provider before initial hospital discharge and 19% were outpatient referrals. Forty-six percent were premature and 50% exhibited oropharyngeal dysphagia. The median duration of nasogastric feeding before GT placement was 36.5 days (IQR: 16-64). In those with GT removal (n = 140), the median duration of use was 269 days (IQR: 144-474), with 23% of the cohort no longer utilizing the GT within 12 months of placement. Patients with congenital lung disease (odds ratio [OR]: 3.03, p = 0.002) and genetic anomalies excluding isolated Trisomy 21 (OR: 3.57, p = 0.003) were more likely to require prolonged GT use. Nearly a quarter of children attain full oral feeding within a year of GT placement. The identified factors predictive of prolonged GT use suggest early placement in these patients. Continuing nasogastric feeds in other patients may decrease the morbidity of unnecessary GT placement.

Tumor burden quantified by Soluble B-Cell Maturation Antigen and Metabolic Tumor Volume determine myeloma CAR-T outcomes.

Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as a breakthrough treatment for relapsed and refractory multiple myeloma (RRMM). However, these products are complex to deliver and alternative options are now available. Identifying biomarkers that can predict therapeutic outcomes is crucial for optimizing patient selection. There is a paucity of data evaluating the utility of both serum soluble B-cell maturation antigen (sBCMA) levels and metabolic tumor volume (MTV) at baseline in patients with RRMM undergoing CAR-T therapy. We identified a cohort of 183 patients with available serum to measure sBCMA and/or pre-treatment MTV, derived from positron emission tomography-computed tomography (PET-CT) scans obtained per standard of care. Expectedly, high pre-treatment levels of sBCMA correlated with other established markers of tumor burden (e.g., bone marrow plasma cells/BMPCs, beta2 microglobulin) and inflammation, and were highly prognostic for CAR-T related toxicities and inferior progression free survival (PFS). High MTV values were also associated with shorter PFS and inferior overall survival (OS). The poor correlation observed between these two measures prompted evaluation of those with discordant results, identifying that those with low sBCMA and high MTV frequently had low/absent BCMA expression on plasma cells and suboptimal response. Our findings highlight the potential utility of sBCMA and MTV to facilitate more personalized treatment strategies in the management of RRMM eligible for BCMA directed CAR-T.

Navigating gastrointestinal endoscopy challenges in the intensive care unit: A mini review.

Patients in the intensive care unit (ICU) may need bedside endoscopy for gastrointestinal (GI) emergencies. Conducting endoscopy in the ICU for critically ill patients needs special consideration. This mini review focuses on indications for bedside endoscopes, including GI bleeding, volvulus, and bowel obstruction. It explains the risks associated with urgent endoscopies in critical patients and outcomes. Hemodynamic instability, coagulopathy, and impaired mucosal visualization are important considerations before bedside endoscopy. It also discusses the anesthesia considerations for non-operating room anesthesia. Multidisciplinary collaboration, meticulous patient selection, and procedural optimization help mitigate risks and maximize procedural success.

Incidence of Avascular Necrosis of the Femoral Head Post Hip Reduction Surgery in Children With Cerebral Palsy.

Avascular necrosis (AVN) of the femoral head confers a risk of morbidity amongst cerebral palsy (CP) patients. Meanwhile, the proportion who develop AVN posthip reduction surgery is unclear, and the risk factors are not established. To estimate the incidence and risk factors for AVN post hip reduction surgery in CP patients, we reviewed and analysed literature from Medline, Embase, and Web of Science repositories between January 1, 1990, and August 31, 2024. The included publications were reviewed for the incidence and risk factors in this cohort of patients. Findings were appraised using the methodological index for non-randomised studies, and scores and results were descriptively analysed. Given the marked heterogeneity of retrieved data, results were reported as standardised values, including the mean weighted incidence rate. A total of 1619 hip reduction surgeries were performed on 1045 CP patients across 12 retrospective studies with 424 cases of AVN. The mean age at surgery ranged from 7.3 to 16.2 across studies. The mean incidence was 0.482% ± 0.06945 per person-year. Most patients were in gross motor function classification system V, with a preoperative mean Reimers index of 54.11-80%. The average methodological items for non-randomised studies score was 10.08/16 ± 0.28 for all studies (n=12). AVN has a definite relationship with hip reductionsurgery. The low methodological quality of reviewed studies informs the need for well-designed prospective randomised controlled studies to understand the mechanics of this relationship in terms of age of surgery and Reimers hip migration index, guide surgical timing, and patient selection.

The effect of single-layer and double-layer graft usage in tympanoplasty on hearing and graft success.

In this study, we investigated whether the use of double layer graft (DLG) in tympanoplasty would increase grafting success rates (GSR) and whether increased graft thickness would negatively affect hearing. The study group consisted of patients with DLG and the control group consisted of patients with single layer graft (SLG). The results of 195 patients in terms of hearing achievement and 211 patients in terms of GSR were compared. Hearing and GSR were analyzed in 103 DLG and 108 SLG patients. Postoperative 6th month air conduction pure tone averages were 25.34 (±14.99) dB in DLG group and 20.50 (±8.82) dB in SLG group. These values were statistically significantly higher in the DLG group (p=0.005). Postoperative air bone gap was 11.40 (±8.61) dB in DLG and 12.95 (±10.88) dB in SLG and there was no statistically significant difference in hearing gain between the groups. GSR was 99/103 (96.1%) in the DLG group and 103/108 (95.4%) in the SLG group with no difference between the groups (p=0.679) CONCLUSION: We concluded that DLG is not superior to SLG in terms of both hearing and GSR, and may even be disadvantageous in terms of hearing, and this should be taken into consideration in patient selection.

The Endoscopic L-shape Approach for Anterior Skull base Meningiomas with Olfactory Preservation: A Technical Note.

The preservation of olfaction during the surgical resection of anterior skull base meningiomas presents a significant challenge. This study presents a modified endonasal endoscopic L-shaped approach designed to maximize tumor resection while preserving olfaction, a vital function that profoundly impacts the quality of life. A cadaveric dissection was conducted to refine the surgical technique, and this approach was subsequently applied to a 34-year-old female patient presenting with a large planum sphenoidale meningioma. Gross total resection was achieved while preserving the patient's left olfactory epithelium and bulb. Olfactory function was assessed three months postoperatively using the Smell Diskettes Test, with the patient scoring 5 out of 8, indicating hyposmia. Follow-up at one year demonstrated preserved olfactory function and no recurrence of the tumor. The L-shaped modification for endoscopic resection of anterior skull base meningiomas provides effective exposure with the possibility of preserving olfaction. Future studies are needed to validate these outcomes, but careful patient selection and meticulous planning are essential for optimal results.

Estimation of heart dose in left breast cancer radiotherapy: Assessment of vDIBH feasibility using the supervised machine learning algorithm.

The volunteer deep inspiration breath hold (vDIBH) technique is used to reduce the heart dose in left breast cancer radiotherapy. Many times, it is faced that despite rigorous exercise and training, not all patients get benefited as expected. The primary objective of this study was to develop a machine learning program for prediction of mean heart dose before left breast radiotherapy under vDIBH. The present work is based on the dosimetric parameters of eighty-two left breast cancer patients, who have undergone modified radical mastectomy, enrolled for their radiation treatment. The trained machine learning algorithm employed linear regression to establish a correlation between Haller Index and heart mean dose (HMD) received during the ca left breast cancer radiotherapy. Subsequently, HMD values were used to model the regression relationship with maximum heart distance (MHD). The method adopted is beneficial in patient selection and assessment for suitability of patients' radiotherapy planning under vDIBH treatment technique. For data from 21 test patients, the mean of HMD obtained from the treatment planning system (TPS) and the mean of predicted HMD by developed program were found to be 468.76 cGy and 464.66 cGy, respectively. The present work facilitates precise HMD prediction in left breast cancer radiation therapy even before starting the treatment planning process. Additionally, this program offers suggestions in terms of modifications in treatment settings for even better results of vDIBH techniques if not matches with the anticipated results.

Endothelin receptor antagonists in chronic kidney disease.

Endothelin-1 is a potent vasoconstrictor that has diverse physiological functions in the kidney, including in the regulation of blood flow and glomerular filtration, electrolyte homeostasis and endothelial function. Overexpression of endothelin-1 contributes to the pathophysiology of both diabetic and non-diabetic chronic kidney disease (CKD). Selective endothelin receptor antagonists (ERAs) that target the endothelin A (ETA) receptor have demonstrated benefits in animal models of kidney disease and in clinical trials. In patients with type 2 diabetes and CKD, the selective ETA ERA, atrasentan, reduced albuminuria and kidney function decline. Concerns about the increased risks of fluid retention and heart failure with ERA use have led to the design of further trials to optimize dosing and patient selection. More recent studies have shown that the dual ETAreceptor andangiotensin receptor blocker, sparsentan, preserved kidney function with minimal fluid retention in patients with IgA nephropathy. Moreover, combined administration of a low dose of the ETA-selective ERA, zibotentan, with the sodium-glucose cotransporter 2 (SGLT2) inhibitor, dapagliflozin, enhanced albuminuria reduction and mitigated fluid retention in patients with CKD. Notably, sparsentan and aprocitentan have received FDA approval for the treatment of IgA nephropathy and treatment-resistant hypertension, respectively. This Review describes our current understanding of the use of ERAs in patients with CKD to guide their optimal safe and effective use in clinical practice.

The Promising Potency of Sodium–Glucose Cotransporter 2 Inhibitors in the Prevention of and as Treatment for Cognitive Impairment Among Type 2 Diabetes Patients

Type 2 diabetes mellitus (T2DM), accounting for the majority of diabetes mellitus prevalence, is associated with an increased risk of cognition decline and deterioration of cognition function in diabetic patients. The sodium–glucose cotransporter 2 (SGLT2), located in the renal proximal tubule, plays a role in urine glucose reabsorption. SGLT2 inhibitors (SGLT2i), have shown potential benefits beyond cardiac and renal improvement in preventing and treating cognitive impairment (CI), including mild cognitive impairment, Alzheimer’s disease and vascular dementia in T2DM patients. Studies suggest that SGLT2i may ameliorate diabetic CI through metabolism pathways, inflammation, oxidative stress, neurotrophic factors and AChE inhibition. Clinical trials and meta-analyses have reported significant and insignificant results. Given their vascular effects, SGLT2i may offer unique protection against vascular CI. This review compiles mechanisms and clinical evidence, emphasizing the need for future analysis, evaluation, trials and meta-analyses to verify and recommend optimal SGLT2i selection and dosage for specific patients.

Nonoperative management of rectal cancer

The management of locally advanced rectal cancer has changed drastically in the last few decades due to improved surgical techniques, development of multimodal treatment approaches and the introduction of a watch and wait (WW) strategy. For patients with a complete response to neoadjuvant treatment, WW offers an opportunity to avoid the morbidity associated with total mesorectal excision in favor of organ preservation. Despite growing interest in WW, prospective data on the safety and efficacy of nonoperative management are limited. Challenges remain in optimizing multimodal treatment regimens to maximize tumor regression and in improving the accuracy of patient selection for WW. This review summarizes the history of treatment for rectal cancer and the development of a WW strategy. It also provides an overview of clinical considerations for patients interested in nonoperative management, including restaging strategies, WW selection criteria, surveillance protocols and long-term oncologic outcomes.

Milk ladder: Who? When? How? Where? with the lowest risk of reaction

The milk ladder (ML) approach, which is the gradual reintroduction of the milk allergen from the least allergenic forms to the most allergenic forms into the diet of the patients, has been utilized mostly in non-IgE-mediated but in some countries also in IgE-mediated-CMPA due to its possible benefits which include nutrition, quality of life and tolerance induction. Despite increasing interest, so far, there is no guideline on ML; thus, the use of this approach shows discrepancies among healthcare professionals as many factors such as dietary habits, patient history, test results, workload, and facilities of the hospitals, the anxiety of the parents/patients may affect the decision on how, when, where and whom to use ML. Here, we reviewed current data on implementing the ML, suggested a 4-step ML including receipts and amounts, and shared our experience on optimal patient selection, appropriate time and steps for initiating ML, and time intervals between the steps targeting the lowest risk of reaction. We also added the newly developed twice-baked biscotti cake to the ML. We presented the analyses of this product, showing its low allergenicity compared to conventional cake, which provides a safer introduction of milk into the diet.

Impact of Robotic Percutaneous Coronary Intervention (R-PCI) With and Without CCTA-Guidance on Clinical Outcomes and Hospital Economics: A Single Center Registry.

Several studies have confirmed the safety and efficacy of robotic assisted coronary interventions for simple and complex coronary lesions. However, in the real-world clinical setting the currently available evidence is still inconclusive with regard to clinical outcomes. In terms of financial sustainability, the emerging use of pre-PCI Coronary Computed Tomography Angiography (CCTA) may potentially impact the overall patient journey and related costs. However, the role of CCTA guidance in elective robotic-assisted revascularizations and its potential impact on hospital economics has never been investigated. Therefore, we aimed to assess the clinical impact of R-PCI according to procedural complexity and its potential financial sustainability when integrated with CCTA guidance. Major adverse cardiovascular events (MACE) at the latest clinical follow-up available have been prospectively evaluated in a single center cohort of 111 patients undergoing elective R-PCI (CorPath, Corindus GRX Robotic Drive, Boston, MA). The study population was subsequently divided into two groups according to either the median Syntax Score (SS = 14) as a surrogate of procedural complexity or the adoption of CCTA-guidance. Additionally, both periprocedural and in-hospital outcomes have been investigated in the overall cohort and in the subgroups. Overall, MACE occurred in 5.4% of the patients at a median follow-up of 309 days. Procedural complexity was associated with significantly longer procedural time and radiation exposure (SS ≥ 14: 94.5 ± 32.1 vs. 78.7 ± 25.5 min, p = 0.011, and 32.7 ± 30.9 vs. 22.5 ± 19.8 mSv, p = 0.010, respectively), but not with increased in-hospital and long-term clinical outcomes. Additionally, patients undergoing CCTA-guided R-PCI had a significantly higher rate of same-day-discharge (SDD-64.6% vs. 44.2% respectively, p = 0.034) than those without CCTA support. R-PCI appears safe and effective regardless the procedural complexity. Moreover, the integration of robotics and CCTA-guidance appears to have beneficial impact on hospital economics by optimizing resource utilization and improving patient selection for percutaneous revascularization.

Low-grade systemic inflammation, but not neuroinflammation, is associated with 12-month postoperative outcome after total hip arthroplasty in patients with painful osteoarthritis.

Better prediction of outcome after total hip arthroplasty (THA) is warranted. Systemic inflammation and central neuroinflammation are possibly involved in progression of osteoarthritis and pain. We explored whether inflammatory biomarkers in blood and cerebrospinal fluid (CSF) were associated with clinical outcome, and baseline pain or disability, 12 months after THA. A total of 50 patients from the Danish Pain Research Biobank (DANPAIN-Biobank) between January and June 2018 were included. Postoperative outcome was assessed as change in Oxford Hip Score (OHS) from baseline to 12 months after THA, pain was assessed on a numerical rating scale, and disability using the Pain Disability Index. Multiple regression models for each clinical outcome were included for biomarkers in blood and CSF, respectively, including age, sex, BMI, and Kellgren-Lawrence score. Change in OHS was associated with blood concentrations of tumour necrosis factor (TNF), interleukin-8 (IL-8), interleukin-6 receptor (IL-6R), glycoprotein 130 (gp130), and IL-1β (R2 = 0.28, p = 0.006), but not with CSF biomarkers. Baseline pain was associated with blood concentrations of lymphotoxin alpha (LTα), TNFR1, TNFR2, and IL-6R (R2 = 0.37, p < 0.001) and CSF concentrations of TNFR1, TNFR2, IL-6, IL-6R, and IL-1Ra (R2 = 0.40, p = 0.001). Baseline disability was associated with blood concentrations of TNF, LTα, IL-8, IL-6, and IL-1α (R2 = 0.53, p < 0.001) and CSF concentrations of gp130, TNF, and IL-1β (R2 = 0.26, p = 0.002). Thus, preoperative systemic low-grade inflammation predicted 12-month postoperative outcome after THA, and was associated with preoperative pain and disability. This study highlights the importance of systemic inflammation in osteoarthritis, and presents a possible path for better patient selection for THA in the future. Preoperative central neuroinflammation was associated with preoperative pain and disability, but not change in OHS after THA.

Outcomes of pancreatectomy for histologically proven intraductal papillary mucinous neoplasm with reference to Fukuoka guidelines.

Intraductal papillary mucinous tumour (IPMN) of pancreas is increasingly recognized to have malignant potential. Fukuoka guidelines are commonly used to select patients with IPMN for resection due to high chance of malignancy, which includes high-grade dysplasia (HGD) or invasive carcinoma (IC). A retrospective study on consecutive patients who have undergone pancreatectomy with IPMN as the final pathology was performed. Operative and survival outcomes were analysed. The positive predictive values (PPV) of high-risk stigmata (HRS) and worrisome features (WF) of Fukuoka guidelines for HGD/IC were determined. Between August 2011 and September 2020, various types of pancreatectomy were performed for 36 patients with histologically proven IPMN. They included 26 pancreaticoduodenectomy, 7 distal pancreatectomy, 2 central pancreatectomy, and 1 total pancreatectomy. There were 30 branch duct type IPMN, 5 main duct type, and 1 mixed type. There was no 30-day mortality. Overall complications and pancreatic fistula occurred in 44.4% and 5.6% of patients, respectively. Patients without HGD/IC had 100% survival at 5 years with no recurrent disease. There were 13 patients with HGD/IC, their 1-, 3-, 5-year overall and disease-free survival were 84.6%, 76.9%, 67.3% and 84.6%, 68.4%, 58.6%, respectively, both significantly shorter than non-HGD/IC group (P = 0.002 and 0.001, respectively). The PPV of HRS and WF for HGD/IC were 33.3% and 23.5%, respectively. The combined PPV of HRS and WF for HGD/IC was 38.0%. Survival after pancreatectomy for IPMN was favourable, but was significantly worse in the presence of HGD/IC. Fukuoka guidelines were useful in predicting malignant IPMN.