Significant Complications Research Articles

Fetal growth restriction - clinical manifestations through the perspective of pathophysiological changes

Intrauterine restriction of fetal growth is one of the most interestings and nowadays  intensively studied problems of modern obstetrics. Fetal growth restriction can lead to significant obstetric complications, as well as consequences after delivery. For the obstetricians the fetal growth means iatrogenic prematurity,  fetal distress, perinatal morbidity but also long term consequences as metabolic disease, cardiovascular pathology and Alzhaimer disease.  There was considerable controversy as to how fetal growth restriction should be defined and diagnosed. Biometric and biophysical tests have been proposed to diagnose growth restriction, but until recently there were no unanimously accepted standards for the diagnosis of this pathology. This definition was reached in 2021 by the FIGO publication. Under the condition of  intrauterine hypoxia adaptation mechanisms are activated. Understanding  the ongoing pathophysiological process of adaptation in a hypoxic media helps to better understand proposed diagnosis criteria and the classification.

Accelerating Diabetic Wound Healing by Modulating the Inflammatory Environment Using Quercetin–Rosemary Oil Lipid Nanoemulsions with Artificial Intelligence‐Based Wound Closure Analysis

AbstractDiabetic wounds are a significant complication of diabetes that is characterized by delayed wound healing and a high risk of amputation. The overexpression of pro‐inflammatory macrophages (M1) and matrix metallo protease‐9 (MMP‐9) plays a crucial role in the extended inflammatory phase, which is characteristic of these wounds. This study develops multifunctional lipid nanoemulsions known as Quercetin and Rosemary Oil Lipid Nanoemulsions (Q‐RLNEs) that can effectively convert M1 to M2 macrophages, inhibit MMP‐9 and prevent microbial infections, thereby expediting the healing of diabetic wounds. Q‐RLNEs exhibit excellent biocompatibility, cellular uptake, ROS scavenging, macrophage polarization, MMP‐9 inhibition, and potent antimicrobial properties against Staphylococcus aureus in vitro. In vivo experiments further reveal Q‐RLNE's ability to accelerate complete wound healing in diabetic‐induced rats by reducing inflammation, promoting angiogenesis, and facilitating proper collagen deposition and dermal projection regeneration. This study introduces the application of the Segment Anything Model (SAM). SAM combines attention‐fusion and hybrid fusion strategies for accurate segmentation, enabling comprehensive analysis of wound attributes over time and guiding treatment decisions. The SAM analysis results also align with Q‐RLNE in vitro and in vivo. The findings of this study suggest that Q‐RLNE is a promising new therapeutic agent for accelerating diabetic wound healing.

Treatment of Severely Shortened or Comminuted Clavicular Fractures in Older Adolescent Athletes

Background: Recent evidence suggests that for completely displaced midshaft clavicular fractures, surgery offers no clear benefit over nonoperative treatment in a general adolescent population from 10 to 18 years of age. However, the comparative outcomes of comminuted and/or severely shortened clavicular fractures specifically in older adolescent athletes have not been explored in a focused, methodologically rigorous fashion. Hypothesis: The study hypothesis was that outcomes would be superior in older adolescent athletes who underwent operative treatment compared with nonoperative treatment for comminuted and/or severely shortened clavicular fractures. Study Design: Cohort study; Level of evidence, 2. Methods: A level 2, multicenter, prospective cohort study investigating the outcomes of midshaft fractures in adolescents between 2013 and 2017 was filtered to analyze the subcohorts of athletes 14 to 18 years of age with either fracture comminution or fracture shortening of ≥25 mm or both. Patient characteristics, injury mechanisms, fracture characteristics, and treatments were compared. Complications, rates, timing of return to sports (RTS), and patient-reported outcomes (PROs) were analyzed. Results: The 2 treatment groups, which included 136 older adolescent athletes (69 nonoperative, 67 operative), showed similar distributions of primary sport type, competition level, comminution, shortening, and 2-year PRO response rate (n = 99; 73%). The operative group demonstrated 3 mm–greater mean superior displacement, which was therefore statistically controlled for as a confounder in the comparative PRO analysis. No 2-year differences in nonunion, delayed union, symptomatic malunion, refracture, clinically significant complications, or rates of RTS were detected between treatment groups. The difference in timing of RTS (operative, 10.3 weeks; nonoperative, 13.5 weeks) was statistically significant. After controlling for the minor difference in superior displacement, regression analysis and matched comparison cohorts demonstrated no differences between the nonoperative and operative groups in mean or dichotomized PRO scores. Conclusion: In this prospective, multicenter cohort study investigating older adolescent athletes with comminuted and/or severely shortened clavicular fractures, contrary to the study hypothesis, there were no differences in complications, RTS, or PROs between nonoperatively and operatively treated patients at 2 years. Comparably excellent outcomes of severe clavicular fractures in adolescent athletes can be achieved with nonoperative treatment.

SARS-CoV-2 immunity in animal models.

The COVID-19 pandemic, which was caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a worldwide health crisis due to its transmissibility. SARS-CoV-2 infection results in severe respiratory illness and can lead to significant complications in affected individuals. These complications encompass symptoms such as coughing, respiratory distress, fever, infectious shock, acute respiratory distress syndrome (ARDS), and even multiple-organ failure. Animal models serve as crucial tools for investigating pathogenic mechanisms, immune responses, immune escape mechanisms, antiviral drug development, and vaccines against SARS-CoV-2. Currently, various animal models for SARS-CoV-2 infection, such as nonhuman primates (NHPs), ferrets, hamsters, and many different mouse models, have been developed. Each model possesses distinctive features and applications. In this review, we elucidate the immune response elicited by SARS-CoV-2 infection in patients and provide an overview of the characteristics of various animal models mainly used for SARS-CoV-2 infection, as well as the corresponding immune responses and applications of these models. A comparative analysis of transcriptomic alterations in the lungs from different animal models revealed that the K18-hACE2 and mouse-adapted virus mouse models exhibited the highest similarity with the deceased COVID-19 patients. Finally, we highlighted the current gaps in related research between animal model studies and clinical investigations, underscoring lingering scientific questions that demand further clarification.

Improving Circulatory Support in Cases of Acute DeBakey Type I Aortic Dissection: A Novel Arterial Cannulation Approach and Its Effects on Perfusion and Minimizing Complications

Objective. Proposing a novel arterial cannulation technique for acute DeBakey type I aortic dissection with severe aortic arch and branch involvement to enhance CPB effectiveness and reduce organ malperfusion complications. Methods. The technique involves retrograde insertion of an arterial perfusion tube into the aortic arch through the left common carotid artery. Extracorporeal circulation is established, and total aortic arch replacement with deep hypothermic systemic circulation and a frozen elephant trunk stent placement are performed to restore lower body perfusion. Results. Six patients with severe aortic arch and branch involvement underwent the new arterial cannulation technique. All patients had smooth postoperative recoveries without significant complications. Conclusion. The novel arterial cannulation technique shows promise in managing acute DeBakey type I aortic dissection with extensive vascular involvement, reducing complications, and enhancing patient outcomes. Further validation with a larger patient cohort is needed to confirm its effectiveness and safety. If successful, this technique could become a valuable addition to treatment strategies for improved outcomes.

Effects of Acapella versus Blow Bottle Positive Expiratory Pressure on Airway Clearance and Peak Expiratory Flow Rate in Post-Covid-19 Patients

Background: The COVID-19 pandemic has led to significant respiratory complications in affected individuals. Positive Expiratory Pressure (PEP) devices, specifically Acapella and blow bottle devices, have been widely used in respiratory rehabilitation, particularly in patients with pulmonary diseases and post-surgical respiratory complications. However, their efficacy in post COVID-19 patients has been less explored. Objective: This study aimed to compare the effectiveness of Acapella and blow bottle devices in improving oxygen saturation, peak expiratory flow rate, shortness of breath, and six-minute walk distance in post COVID-19 patients. Methods: This randomized clinical trial was conducted at Tehsil hospital Kot Addu over six months. Forty-eight post COVID-19 patients were divided equally into two groups: one group received treatment with the Acapella device, and the other with a blow bottle device. Baseline and post-treatment measurements of oxygen saturation, peak expiratory flow rate, and six-minute walk distance were recorded using a pulse oximeter, peak expiratory flow meter, and six-minute walk test, respectively. Results: On day 1, the Acapella group showed a mean oxygen saturation rank of 20.98 with a sum of ranks of 503.50 (p=0.79), while the Blow Bottle group had a mean rank of 28.02 and a sum of ranks of 672.50. By day 7, the Acapella group's mean rank was 17.31 (sum of ranks = 415.50, p=0.000) compared to the Blow Bottle group's 31.69 (sum of ranks = 760.50). For peak expiratory flow rate, no significant differences were found between the groups at day 1 (Acapella: mean rank = 28.06, sum of ranks = 673.50, p=0.078; Blow Bottle: mean rank = 20.94, sum of ranks = 502.50) and day 7 (Acapella: mean rank = 23.77, sum of ranks = 570.50, p=0.717; Blow Bottle: mean rank = 25.23, sum of ranks = 605.50). Similar trends were observed in the six-minute walk test results. Conclusion: The study found that both Acapella and blow bottle devices effectively improve oxygen saturation in post COVID-19 patients, but do not significantly affect peak expiratory flow rate, shortness of breath, and six-minute walk distance. These findings suggest that while these devices are beneficial for enhancing oxygenation, a more comprehensive respiratory rehabilitation approach is necessary for addressing the full spectrum of respiratory complications in post COVID-19 patients.

Outcomes of Mohs micrographic surgery for periocular squamous cell carcinoma.

Periocular cutaneous squamous cell carcinoma (cSCC) accounts for 5-10% of all eyelid malignancies. Periocular cSCC carries a low mortality rate but can be destructive to local tissues. Due to the unique function and anatomy of the eyelids, Mohs micrographic surgery (MMS) is gold standard for treating cSCC to preserve healthy tissue and reduce rates of local recurrence. In this study, we describe the success and outcomes of MMS and subsequent oculoplastic reconstruction for periocular cSCC in the North East of England. Retrospective analysis of 34 patients who underwent MMS for periocular cSCC in the North of England between 2013 and 2020. Primary outcome measure of success is defined as no recurrence of cSCC after minimum 24 months' time elapsed post-MMS. Secondary outcome measures included analysis of disease characteristics, describing the surgical techniques utilised for oculoplastic reconstruction following MMS and surgical complications should they occur. Two patients (5.9%) had local recurrence of periocular cSCC. Median time elapsed since MMS was 60 months. A variety of oculoplastic surgical techniques were utilised in the repair of the Mohs defect. One patient (2.9%) developed a significant post-operative reconstruction complication. Periocular cSCC recurrence following MMS in the North of England is 5.9%, which is comparable to the literature. Significant post-operative complications following oculoplastic reconstruction of periocular MMS are very low, occurring in 2.9% of cases in this study.

Outcomes of Completion Lobectomy for Locoregional Recurrence after Sublobar Resection in Patients with Non-small Cell Lung Cancer.

This retrospective study aimed to determine the treatment patterns and the surgical and oncologic outcomes after completion lobectomy (CL) in patients with locoregionally recurrent stage I non-small cell lung cancer (NSCLC) who previously underwent sublobar resection. Data from 36 patients who initially underwent sublobar resection for clinical, pathological stage IA NSCLC and experienced locoregional recurrence between 2008 and 2016 were analyzed. Thirty-six (3.6%) of 1,003 patients who underwent sublobar resection for NSCLC experienced locoregional recurrence. The patients' median age was 66.5 (range, 44-77) years at the initial operation, and 28 (77.8%) patients were men. Six (16.7%) patients underwent segmentectomy and 30 (83.3%) underwent wedge resection as the initial operation. The median follow-up from the initial operation was 56 (range, 9-150) months. Ten (27.8%) patients underwent CL, 22 (61.1%) underwent non-surgical treatments (chemotherapy, radiation, concurrent chemoradiation therapy), and 4 (11.1%) did not receive treatment or were lost to follow-up after recurrence. Patients who underwent CL experienced no significant complications or deaths. The median follow-up time after CL was 64.5 (range, 19-93) months. The 5-year overall survival (OS) and post-recurrence survival (PRS) were higher in the surgical group than in the non-surgical (p<0.001) and no-treatment groups (p<0.001). CL is a technically demanding but safe procedure for locoregionally recurrent stage I NSCLC after sublobar resection. Patients who underwent CL had better OS and PRS than patients who underwent non-surgical treatments or no treatments; however, a larger cohort study and long-term surveillance are necessary.

Continuous direct intraarterial treatment of meningitis-induced vasospasm in a pediatric patient: illustrative case.

Bacterial meningitis-induced ischemic stroke continues to cause significant long-term complications in pediatric patients. The authors present a case of severe right internal carotid artery terminus and M1 segment vasospasm in a 9-year-old with an infected cholesteatoma, which was refractory to multiple intraarterial treatments with verapamil and milrinone. This is the first report of continuous intraarterial antispasmodic treatment in a pediatric patient as well as the first report of continuous treatment in an awake and extubated patient. Arterial narrowing was successfully treated by continuous direct intraarterial administration of both a calcium channel blocker (verapamil) and a phosphodiesterase-3 inhibitor (milrinone). The patient recovered remarkably well and was discharged home with no neurological deficit (National Institutes of Health Stroke Scale score 0) and ambulatory without assistance after 22 days. The authors report a promising outcome of this technique performed in a pediatric patient. This represents a novel treatment option for the prevention of stroke in pediatric bacterial meningitis. Continuous, direct intraarterial administration of antispasmodic medications can successfully prevent long-term neurological deficit in pediatric meningitis-associated vasospasm. The described method has the potential to significantly improve outcomes in severe pediatric meningitis-associated vasospasm.

Presentation and outcomes of paediatric craniopharyngioma in the west of Scotland: a 25 year experience.

Craniopharyngiomas can be aggressive leading to significant complications and morbidity. It is not clear whether there are any predictive factors for incidence or outcomes. Our aim was therefore to record the incidence, presentation, characteristics and progression of paediatric craniopharyngiomas in the West of Scotland. Retrospective case note review for children diagnosed with paediatric craniopharyngiomas at the Royal Hospital for Children Glasgow, from 1995 to 2021 was conducted. All analyses were conducted using GraphPad Prism 9.4.0. Of 21 patients diagnosed with craniopharyngiomas, the most common presenting symptoms were headaches (17/21, 81%); visual impairment (13/21, 62%); vomiting (9/21, 43%) and growth failure (7/21, 33%). Seventeen (81%) patients underwent hydrocephalus and/or resection surgery within 3 months of diagnosis, usually within the first 2 weeks (13/21, 62%). Subtotal resection surgeries were performed in 71% of patients, and median time between subsequent resection surgeries for tumour recurrence was 4 years (0,11). BMI SDS increased at 5 year follow-up (p = 0.021) with 43% being obese (BMI > + 2SD). More patients acquired hypopituitarism post-operatively (14/16, 88%) compared to pre-operatively (4/15, 27%). A greater incidence of craniopharyngiomas were reported in more affluent areas (10/21, 48%) (SIMD score 8-10) compared to more deprived areas (6/10, 29%) (SIMD score 1-3). Five patients (24%) died with a median time between diagnosis and death of 9 years (6,13). Over 25 years the management of craniopharyngioma has changed substantially. Co-morbidities such as obesity are difficult to manage post-operatively and mortality risk can be up to 25% according to our cohort.

P-82 Riedel's thyroiditis: three-year follow-up under steroid, rituximab and mycophenolate mofetil treatment

Abstract Introduction Riedel's thyroiditis (RT) is an uncommon thyroiditis characterized by fibrosis, macrophage, and eosinophil infiltration and is assumed to be the primary cause of autoimmunity in the pathogenesis. Invasion of the surrounding tissues, particularly the trachea, occurs. RT is also regarded as thyroid involvement in IgG4-related systemic illness. Because there is no conventional medical treatment protocol for RT, this paper aims to highlight the problems we had in diagnosing and our approach throughout therapy. Clinical Case In the last 1.5 years, a 44-year-old female patient on levothyroxine replacement diagnosed with hypothyroidism developed bilateral swelling in the eyes, double vision, drooping eyelids, shortness of breath, and feeling something lodged in the throat. A diffusely enlarged and stiff thyroid gland was palpated in her physical examination. Neck CT revealed a diffusely enlarged thyroid gland 7cm in diameter and constricted trachea. She did not have any constitutional symptoms. According to physical and radiologic exams, preliminary differential diagnoses were anaplastic thyroid carcinoma and IgG4-related thyroiditis. In laboratory tests, TSH: 4.5 mIU/L, st3-4: normal, Anti TPO: +++ TRAB: 0.15 U/L, ANA: Negative, IgG4: 0.52 g/L (0.03-2.01), ACE:21.39. Since the thyroid fine needle aspiration biopsy reported a hypocellular smear, a lacrimal gland biopsy was performed for systemic involvement of IgG4 related disorder's. Her dyspnea was becoming critical; therefore, she was administered 0.5 mg/kg steroid for two weeks before the scheduled bilateral total thyroidectomy, and a considerable decrease in dyspnea, swallowing sensations, and regression in compression findings were seen. Lacrimal biopsies demonstrated persistent inflammation with plasma cells and severe fibrosis, consistent with late-stage IgG4-related illness. Both thyroid lobes were enlarged in neck T1 and T2-weighted MRI images (right lobe was 34×25×68 mm, the left lobe was 35×26×69 mm), diffuse hypointensity was noted, contrast uptake decreased in the thyroid parenchyma following IVCM, and the data was determined to be compatible with RT. The thyroid gland grew markedly on PET-CT, narrowing the air column, with increased FDG absorption in a heterogeneous character (SUVmax: 4.9), and mild-moderate involvement in bilateral lacrimal and parotid glands.The decision was made to continue steroid treatment at 1 mg/kg for one month. Rituximab was given twice every six months while the steroid was lowered. Mycophenolate mofetil (MMF) (2×500 mg) was introduced as a maintenance immunosuppressive medication. The initial radiologic findings regressed in the control neck MRI and PET-CT in the first year. The MRI findings were also steady in the second and third years of MMF. Conclusion Immunosupression therapy with steroid, rituximab and MMF was effective in our RT patient for the long term without significant complications. Clinical and radiological responses similar to surgery can be obtained with immunosuppressive agents.Figure 1.PET-CT and MRI images at diagnosis and third year

Total hip replacement after prior of the core decompression of the femoral head: efficacy and complications

Relevance. A history of core decompression using porous tantalum rods has a negative impact on the course of total hip arthroplasty surgery, the postoperative period and the frequency and nature of postoperative complications. Opinions are contradictory with regard to the effect of other techniques of necrosis decompression on total hip arthroplasty.Purpose of the study: evaluation of the effect of core decompression of the femoral head on the intraand postoperative parameters of total hip arthroplasty surgery.Object and methods. The study included 44 patients with osteonecrosis of the femoral head who underwent total hip arthroplasty. The first group consisted of 30 patients with osteonecrosis of the femoral head (ARCO grade II-IV) who had no previous hip surgery – primary total hip arthroplasty. The second group included 14 patients with osteonecrosis who had undergone the core decompression on the same joint (secondary total hip arthroplasty) 6–24 months earlier in stage II of the disease. The duration of surgery, blood loss volume, complications in the postoperative period, pain syndrome dynamics and hip joint function were assessed.Results. Comparative analysis showed the absence of significant technical intraoperative complications in total hip arthroplasty: duration of operations in group I – 85 ± 25 minutes, in group II – 80 ± 20 minutes, that is, almost identical; volume of intraoperative blood loss: 300 ± 100 ml in both groups. Survival rate of the hip replacement was 100 % in both groups. Superficial inflammation of the operating wound was diagnosed in 3.3 % of group I patients and in 7.1 % of group II patients (%). Dislocation of the hip replacement was observed in one patient in Group I (primary total hip arthroplasty). Twelve months after THA, osteolysis around the hip replacement element was detected by X-ray in 6.7 % of group I patients.Conclusion. Total hip arthroplasty in patients with a history of the core decompression of the femoral head is not accompanied by intraoperative technical difficulties and is a relatively safe surgical intervention. Prior core decompression is not an additional risk factor for intraand postoperative complications of total hip arthroplasty.

A functional brace for treating Colles fractures; volunteer trial of a new design

BackgroundPresently used Colles' fracture treatments have similar outcomes with significant complications. Previous studies of a dynamic functional fracture brace, achieving similar or better results had no significant complications. A novel brace design is described to achieve optimal patient outcomes. MethodsPatient forearm measurements combined with data from a previously tested brace provided parameters for a brace formed using computer assisted design. Fracture swelling was simulated using a 40 ml (ml) plastic water filled bag placed over the dorsum of the lower radius. The interface pressure between the brace, skin and bag were measured on twelve human volunteers, four with forearm measurements to fit each of small, medium and large brace sizes. Measurements were taken at intervals reducing volume of fluid in the bag by 10 ml until empty, first wearing a brace, and then with a Colles plaster of Paris cast. FindingsThe brace produced interface pressures over the lower radius in the range of 62.5–90 (mm Hg) and when the bag was completely empty the pressure range was 43–83 mmHg. The initial interface pressures in the Colles casts were in the range of 15–18 mm of Mercury (mm Hg) and when 10 mls were removed from the plastic bag the interface pressure dropped immediately to almost zero. InterpretationThe brace measurements show pressures higher than a Colles cast which compensate for reduction of simulated swelling. It is safe and is potentially the optimal design to achieve significantly improved patient outcomes.

Endoscopic Management of Gastric Disruptions

Gastric perforations and leaks are significant complications that can arise from various gastrointestinal disorders and surgical interventions. Over the past decade, endoscopic techniques have emerged as an effective method for managing these conditions. Furthermore, as endoscopic resection techniques have grown in popularity, the risk of acute and delayed perforations has also grown. This review aims to provide an in-depth analysis of the endoscopic management strategies employed in the management of gastric perforations and leaks. We will discuss the etiology, diagnostic modalities, and various endoscopic techniques utilized, as well as emerging trends in endoscopic management. Our attempt in writing this review paper is to educate and guide clinicians in making informed decisions when faced with gastric perforations and leaks.

Clinical characteristics of hospitalized male adolescents and young adults with atypical anorexia nervosa.

To describe the clinical characteristics of male adolescents and young adults hospitalized for medical complications of atypical anorexia nervosa (atypical AN) and to compare their clinical characteristics with females with atypical AN and males with anorexia nervosa (AN). A retrospective review of electronic medical records for patients with atypical AN and AN aged 9-25 admitted to the UCSF Eating Disorders Program from May 2012 to August 2020 was conducted. Among 21 males with atypical AN (mean age 15.1 ± 2.7, mean %mBMI 102.0 ± 11.8), medical complications evidenced by admission laboratory values included anemia (52.9%), vitamin D insufficiency/deficiency (52.6%), and zinc deficiency (31.6%). Compared with females with atypical AN (n = 69), males with atypical AN had longer length of stay (11.4 vs 8.4 days, p = .004), higher prescribed kcal at discharge (4114 vs 3045 kcal, p < .001), lower heart rate nadir (40.0 vs 45.8, p = .038), higher aspartate transaminase (AST, 37.9 vs 26.2 U/L, p = .032), higher alanine transaminase (ALT, 30.6 vs 18.3 U/L, p = .005), and higher rates of anemia (52.9% vs 19.4%, p = .005), with no differences in vitamin D, zinc, and vital signs. Compared with males with AN (n = 40), males with atypical AN had no significant differences in vital signs or laboratory assessments during the hospitalization. Atypical AN in males leads to significant medical comorbidity, and males with atypical AN require longer hospital stays compared to females with atypical AN. Rates of abnormal vital signs and abnormal serum laboratory values during hospital admissions do not differ in males with atypical AN compared to AN. Adolescent and young adult males with atypical anorexia nervosa experience significant medical complications. Males with atypical anorexia nervosa had longer hospitalizations and higher prescribed nutrition at discharge than females. Medical complications of atypical anorexia nervosa in male adolescents and young adults were generally equal to those of male adolescents and young adults with anorexia nervosa. Clinicians should be aware of unique medical complications of males with atypical anorexia nervosa.

Analysis of surgical treatment of patients with pancreatic cancer at the Samara Regional Clinical Oncological Dispensary

BACKGROUND: Surgery is the only treatment option for tumors of the head and tail. To date, the most optimal operations used for tumors of the head of the pancreas are gastro-pancreatoduodenal resection, and for tumors of the tail — distal subtotal resection of the pancreas and splenectomy. The main access for these operations is median laparotomy. In our article, we analyze the surgical interventions that have been performed for pancreatic cancer in our center, Samara Regional Clinical Oncological Dispensary.&#x0D; AIM: Analysis of surgical interventions for pancreatic cancer in the Samara Regional Clinical Oncological Dispensary to assess the immediate and long-term results of surgical treatment.&#x0D; METHODS: This article presents the results of treatment of 236 patients with pancreatic cancer in the Department of abdominal Oncology of the Samara Regional Clinical Oncology Dispensary from 2018 to 2023. Most patients underwent surgical interventions, including choledochal stenting, bile duct drainage, and cholecystostomy. In inoperable or unresectable processes, palliative surgery was performed, such as the formation of cholecystoenteroanastomosis and gastroenteroanastomosis. Most of the patients underwent radical surgery, and some of them were preceded by neoadjuvant polychemotherapy. In the postoperative period, various reconstruction methods were performed, including the formation of pancreato-gastro-anastomosis and pancreatoejunoanastomosis. Combined operations were also performed in some patients with tumor invasion of adjacent organs.&#x0D; RESULTS: The medical records of 99 patients who underwent radical surgery were examined. 30 of them had significant clinical complications according to the Clavien–Dindo classification and included pancreatic fistula, failure of pancreatoejunoanastomosis, failure of pancreato-gastro-anastomosis and subhepatic abscess. All patients underwent laparotomy, sanitation and drainage of the abdominal cavity, and continued treatment in intensive care units. Some patients required a relaparotomy to stop intra-abdominal erosive bleeding. The mortality rate was 12.02%, the cause of death in some cases was the failure of pancreatoenteroanastomosis together with pancreatic fistula and cardiopulmonary insufficiency caused by pulmonary embolism. The patients were divided into four groups depending on the operation performed. Mortality after distal subtotal pancreatic resection was 2.02%, after.&#x0D; CONCLUSION: Surgical intervention is the main method of treating pancreatic cancer. Radical surgery is a key factor that affects the prognosis of the disease. However, the lack of verification of pancreatic cancer before admission to the hospital does not allow chemotherapy to be performed in the mode of preoperative treatment for a common form of the disease. In about 70% of patients, the syndrome of mechanical jaundice becomes the first manifestation of the disease, which requires additional methods of diagnosis and treatment. The complexity of the operation lies in the proximity of the pancreas to vascular structures. Most patients are already inoperable at the time of diagnosis confirmation due to the spread of the tumor process. Due to the technical complexity of operations, the high number of complications and high postoperative mortality, treatment of pancreatic cancer should be carried out in large specialized centers. The treatment of the disease requires interdisciplinary cooperation to achieve optimal diagnosis.

Multiple Gestations: Neonatal and Maternal Characteristics

Introduction Multiple gestation neonates are commonly found in older age women along with increasing use of assisted reproductive techniques. They are at an increased risk of complications and also impose financial, emotional, social, and psychological burdens on the family. There is a paucity of studies on multiple gestations in India, hence this study was conducted to evaluate the clinical profile and associated comorbidities in neonates born through multiple gestations which can help in anticipating, preparing, and managing possible complications. Methodology This was a prospective observational study conducted in a Level III neonatal intensive care unit of a tertiary care hospital. All intramural neonates delivered with multiple gestations were included. Data regarding the antenatal, perinatal, and hospital course of the neonates were documented. Results A total of 75 intramural neonates (36 twins and 1 triplet) were enrolled in the study. About 67.6% were delivered via caesarean section and 81.1% were spontaneous conception. The most common maternal complications observed were hyperemesis gravidarum (56.76%) followed by pregnancy-induced hypertension (PIH) (40.54%). About 80% of twin neonates were diamniotic dichorionic (DADC) and 42% of twin neonates had vertex-vertex presentation. Almost 22.7% of neonates required neonatal resuscitation and 98% had a birth weight &lt;2.5 kg. Initiation of breastfeeding was delayed, and longer hospital stay was observed in preterm neonates with birth weight ≤1.5 kg and birth weight discordance. Conclusion Multiple gestations are associated with significant neonatal complications owing to prematurity and low birth weight. Thorough knowledge of these complications helps in better fetal and neonatal surveillance and prevention of adverse outcomes.

Potential of Modulating Aldosterone Signaling and Mineralocorticoid Receptor with microRNAs to Attenuate Diabetic Kidney Disease.

Diabetic Kidney Disease (DKD) is a significant complication of diabetes and primary cause of end-stage renal disease globally. The exact mechanisms underlying DKD remain poorly understood, but multiple factors, including the renin-angiotensin-aldosterone system (RAAS), play a key role in its progression. Aldosterone, a mineralocorticoid steroid hormone, is one of the key components of RAAS and a potential mediator of renal damage and inflammation in DKD. miRNAs, small noncoding RNA molecules, have attracted interest due to their regulatory roles in numerous biological processes. These processes include aldosterone signaling and mineralocorticoid receptor (MR) expression. Numerous miRNAs have been recognized as crucial regulators of aldosterone signaling and MR expression. These miRNAs affect different aspects of the RAAS pathway and subsequent molecular processes, which impact sodium balance, ion transport, and fibrosis regulation. This review investigates the regulatory roles of particular miRNAs in modulating aldosterone signaling and MR activation, focusing on their impact on kidney injury, inflammation, and fibrosis. Understanding the complex interaction between miRNAs and the RAAS could lead to a new strategy to target aldosterone signaling and MR activation using miRNAs. This highlights the potential of miRNA-based interventions for DKD, with the aim of enhancing kidney outcomes in individuals with diabetes.

Effect of ozone gas on viral kinetics and liver histopathology in hepatitis C patients.

We examine how well ozone/oxygen gas therapy treats chronic hepatitis C patients with varying degrees of liver fibrosis. Also to study the effect of giving multiple anti-oxidants with the ozone/oxygen gas mixture, to see if this addition would have any additive or synergistic effect. Two hundred and twenty three patients with chronic hepatitis C. Liver biopsies were carried out at after 12weeks of administering an ozone/oxygen gas mixture. The mean stage of fibrosis decreased from 1.98 to 1.41 and the mean grade of inflammation decreased from 10.08 to 7.94, both with a p value less than 0.001. After 12weeks of treatment, mean PCR values increased. No single significant complication was recorded in a total of >9,000 settings of ozone therapy. Ozone oxygen gas mixture is safe and effective in treatment of hepatic fibrosis due to chronic viral hepatitis C.

Direct Repair of Symptomatic Lumbar Spondylolysis Using Rod-Screw-Cable System

To assess the efficacy of a new direct lysis repair technique using internal fixation with rod, screws, and Songer cable in symptomatic lumbar spondylolysis. Between December 2015 and January 2020, patients who were diagnosed with symptomatic lumbar spondylolysis and surgically treated with a rod-screw-cable system were recruited. Pedicle screwing by the Magerl technique was performed in all included patients, followed by direct lysis repair with bone allograft and demineralized bone matrix by stabilizing the posterior lamina and spinous process using a rod-screw-cable system. Clinical outcome was measured using the visual analog scale and Oswestry disability index preoperatively and 6weeks, 3months, 6months, 1year, and 2years postoperatively. Sixteen patients were included in this study-11 men and 5 women (mean age: 47years; range, 26-67years). The lytic defects were at L4 and L5 in 6 and 10 patients, respectively. The mean follow-up period was 41months (24-62months). The visual analog scale values were 7.3, 6.1, 4.3, 3.3, 2.1, and 1.9 preoperatively and 6weeks, 3months, 6months, 1year, and 2years postoperatively, respectively. The Oswestry disability index values were 59.8%, 55.4%, 41.7%, 32.4%, 21.1%, and 16.9% for the same periods, respectively. No patient had an increase in the slip after surgery. There were no significant complications such as implant failure. Our technique provides rigid intra-segmental repair of spondylolysis without intersegmental motion interference, even if the patient is older or has disc degeneration.