University Medical College Research Articles

3048PARADIGM-Extend prospective academic trial: Accumulating long-term evidence for MicroNet-covered stent safety and stroke prevention efficacy

Abstract Aims To provide long-term clinical (incl neurologic) and duplex ultrasound (DUS) evaluation of the CGuard MicroNet-covered embolic prevention stent system (EPS) routine use to perform CAS in all-comer (no exclusion criteria) patients with symptomatic or increased-stroke-risk asymptomatic carotid stenosis recommended for revascularization by the NeuroVascular Team. Methods and results PARADIGM-Extend is a non-industry-funded, prospective academic study in all-referrals-tracked symptomatic and asymptomatic carotid stenosis. In asymptomatic lesions, intervention is mandated only in case of increased-stroke-risk features. There is first-line consideration to use the study device, with EPD choice according to tailored-CAS algorithm. Independent neurologist evaluation and DUS are performed before CAS, at 48h, 30 days, and then every 12 months. There is external source data verification, external angiographic corelab, and external statistical analysis. Currently 325 patients (48–87 years, 54.2% symptomatic) crossed the 1st follow-up window. There has been 100% CGuardEPS use. Angiographic DS was reduced from 84±8% to only 6.9±5% (p<0.001, “CEA-like” effect of CAS). Peri-procedural death or major stroke rate was 0%. One event was CEC-adjudicated as minor stroke (0.3%), and there was one (type2) MI (0.3%). By 30 days there was one haemorrhagic transformation leading to death (0.3%) and one bleeding-related death (0.3%). Thus total death/major stroke/minor stroke rate at 30 days was 0.9%, and total death/major stroke/minor stroke/MI rate at 30 days was 1.2%. At 1- 12 months were no strokes or stroke-related deaths (0%). At 12–24 months there was one cerebellar stroke in an AFib patient that was confirmed on MRI imaging but no carotid-territory stroke or stroke deaths (0%). By 24 and 36 months there was one posterior circulation (cerebellal) infarct but no cerebral infarctions. Post-procedural in-stent velocities were normal and remained normal throughout the 36-month follow-up period (peak-systolic/end-diastolic velocity 0.69±0.29/0.18±0.09 m/s at 30 days, 0.82±0.47/0.22±0.13m/s at 12 months, 0.73±0.31/0.19±0.09m/s at 24months and 0.80±0.31/0.21±0.11 at 24months), indicating normal device healing. Conclusions PARADIGM-Extend accumulating 36-month clinical and DUS evidence is consistent with unprecedented, sustained safety and cerebral embolism prevention efficacy of the CGuard™ MicroNET-covered embolic prevention stent system used routinely for stroke prevention in symptomatic and increased-stroke-risk asymptomatic subjects with carotid stenosis. Acknowledgement/Funding K/ZDS/007819 Jagiellonian University Medical College

EFFECTS OF OCIMUM SANCTUM IN RELIEVING ANXIETY: AN EXPERIMENTAL STUDY.

20Sep 2019 EFFECTS OF OCIMUM SANCTUM IN RELIEVING ANXIETY: AN EXPERIMENTAL STUDY. Sachin G. Jagdale , Ramchandra P.Limaye and Ravindra P. Kulkarni. Resident, Dept of Pharmacology BharatiVidyapeeth (Deemed to be University) Medical College & Hospital, Sangli. Professor, Dept of Pharmacology BharatiVidyapeeth (Deemed to be University) Medical College & Hospital, Sangli. I/C scientist, CAH, Dept of Pharmacology BharatiVidyapeeth (Deemed to be University) Medical College & Hospital, Sangli.

Comparison of Calcium Hydroxide, Chlorhexidine and Triple Antibiotic Paste As Intracanal Medicaments In Patients With Acute Periapical Infections

Objective: To compare the effects of calcium hydroxide, triple antibiotic paste (TAP) and chlorhexidine (CHX) as the intra-canal medicaments in post-operative pain reduction. Study Design and Setting: This was a Quasi experimental study conducted in Bahria University Medical and Dental College, Department of Operative Dentistry for the period of six months. Methodology: Patients with acute periapical infections in single rooted teeth were divided into 3 groups. Group 1 received Calcium hydroxide, group 2 received Chlorhexidine and group 3 received Triple antibiotic paste as intracanal medicament. Each group comprised of 30 patients therefore the total participants of the study were 90. Patients were recalled on 2nd, 7th and 15th day postoperatively and the pain was recorded by using Visual Analogue Scale. Results: Among the study participants; two patients receiving calcium hydroxide were pain free after 2 days and this number increased to 11patients after 7 days. From the CHX group; nine patients were pain free after two days and 23 patients reported no pain after 7 days. In TAP paste group 3 patients reported no pain after 2 days and 22 after 7 days. No patient reported pain after 15 days in any group. Data was statistically analyzed by using SPSS version 23 and Chi-square test was used for descriptive analysis. Conclusion: Intra-canal medicaments significantly reduced inter-appointment pain. The chlorhexidine and triple antibiotic paste were more effective as compared to calcium hydroxide

Awareness Of Medical Students Regarding Periodontal Disease In Diabetic Patients In A Private Dental College of Karachi

Objective: The aim of this study was to evaluate the awareness and knowledge of periodontal disease among medical students of Bahria University Medical and Dental College (BUMDC) while treating diabetic patients. Study design and Setting: It was a cross sectional study conducted in Bahria University Medical and Dental College (BUMDC) Karachi. Methodology: This study included participants currently studying in 3rd, 4th and final year Bachelor of Medicine and Bachelor of Surgery (MBBS) in BUMDC Karachi. Questionnaire was divided into two parts, in the first part, demographic details and year of study were asked, in the second part, questions regarding diabetes mellitus and its complications were included. Total of 384 participants participated in the study and the data was statistically analyzed using responses SPSS version 23. Results: All the participants successfully completed the questionnaire so the response rate was 100% in this study. From 384 participants, 37% were male and 63% were female. The majority of the students were aged between 22-23 years. About 64.1% of respondents thought that they were aware of periodontal disease in diabetic patients whereas only 19.5% individual had knowledge of periodontitis. Also around 44% of medical students could not specify clinical manifestations in periodontitis and only 48.4% participants could state the periodontal manifestations present in diabetic mellitus. Conclusion: It is concluded from the study that medical students have very limited knowledge regarding periodontal disease and its association with diabetes mellitus. Very few medical students were informed about referring the diabetic patients to the dental surgeon.

Editorial introductions

Editorial introductions

Extracellular pH Map of Rat Brain Glioma

Background: This study aimed to evaluate whether chemical exchange saturation transfer (CEST) techniques can detect extracellular pH (pHe) in rat glioma using nonionic X-ray iodinated contrast agents (iobitridol), as well as to construct a quantitative pHe map. Methods: CEST pH imaging was performed on iobitridol phantoms and rats with brain gliomas. Different radio frequency (RF) powers (1.5, 3.0, and 6.0 μT) were used based on ratio of RF power mismatch (RPM) techniques. RPM of 1.5/6.0 μT and 3.0 /6.0 μT were used. Findings: Within the pH range of 5.7-7.3, the CEST effect ratio of iobitridol logarithm exhibited an excellent linear relationship with pH, independent of the concentration of iodobiol. The CEST pHe image was successfully depicted in vivo at the locality of gliomas. The mean pHe of gliomas at pH 1.5 / 6.0 μT and pH 3.0 / 6.0 μT was acidic (pH 1.5 / 6 .0 μT = 6.29 ±0.17, pH 3.0 / 6.0 μT = 6.92 ±0.13). Interpretation: Non-invasive CEST imaging detected extracellular acidic microenvironment of brain gliomas, with spatial resolution sufficient to construct a quantitative pHe map, showing great potential of the technique for clinical applications. Funding: This project was supported by the National Natural Science Foundation of Guangdong and the National Natural Science Foundation of China. Declaration of Interest: The authors stated that there are no conflicts of interest regarding the publication of this article. Ethical Approval: All animal experiments in this study were performed according to the guidelines of the Chinese Animal Welfare Agency, and the specific protocols were approved by the Ethics Committee of Shantou University Medical College.

Oncogenic Activation of the HRR Pathway Drives RAD54L Expression in Early Stage Lung Adenocarcinoma

Background: The current study aims to identify the key dysregulated genes and its related pathways in early progression of lung adenocarcinoma (LUAD). Methods: TCGA dataset of LUAD including 59 healthy lung tissues and 517 tumor tissues were utilized to detect differentially expressed mRNAs and lncRNAs. Gene ontology (GO) analysis was conducted with DAVID, while Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis of differentially expressed genes was performed using gene set enrichment analysis (GSEA) methods. Findings: 41 lncRNAs and 2,047 mRNAs were screened out as they were differentially expressed in LUAD. Besides, 38 lncRNAs and 1,801 mRNAs were found to be differentially expressed in T1 stage LUAD used 8th edition IASLC staging. The homologous recombination repair (HRR) pathway was found to be significantly up-regulated in LUAD, with four genes in this pathway up-regulated. In these genes of HRR pathway, PPP4R4 and RAD54L were recognized to be significantly differentially expressed in T1 stage, compared with T2 stage and T3 stage, which were putative biomarkers of early stage lung adenocarcinoma. The survival analysis revealed that expression of RAD54L was significantly related to survival rate (HR 1.54, 95% CI, 1.16-2.06; p=0.003) in patients with T1 stage tumor. Interpretation: HRR pathway was up-regulated in LUAD, in which the expression of PPP4R4 and RAD54L were found to be tumor stage-specific. RAD54L was associated with worse overall survival rate of T1 stage patients. This study suggests a potential mechanism of lung cancer progression in T1 stage patients. Funding Statement: The study was supported by Medical Scientific Research Foundation of Guangdong Province, China (Grant number B2018148), Science and Technology Program of Guangzhou, China (Grant number 201903010028), Natural Science Foundation of Guangdong Province, China (Grant number 2018A0303130113) and Guangdong Medical University College Students Innovation Experiment Project, China (Grant number ZZZF001). Declaration of Interests: All authors report no conflicts of interest.

Evaluation of credibility and repeatability of modified acetabular fracture classification system

The Letournel-Judet classification system for acetabular fractures is widely used, but there are still some shortcomings, such as incomplete classification and confusion of classification concepts, which cannot effectively guide the treatment. Professor Hou Zhiyong proposed and elaborated an improved acetabular fracture classification system based on the concept of three columns of acetabulum. However, the credibility and repeatability of the classification still lacked validation from clinical data. In this regard, the author included 463 patients with relatively complete imaging data admitted to Third Hospital of Hebei Medical University and Honghui Hospital affiliated to Xi'an Jiaotong University Medical College in the past five years. Four trauma orthopedists classified the patients according to the modified classification method of acetabular fracture. After two months, the original sequence of imaging data was disrupted and re-classified by the same trauma orthopedists. The consistency of the classification was evaluated by Kappa test and compared with Letournel-Judet classification. The results showed that credibility and repeatability of the modified classification were higher than Letournel-Judet classification, suggesting the feasibility of clinical application. Key words: Hip fractures; Acetabulum; Modified acetabular fracture classification

The efficacy and safety of different antimicrobial regimens in carbapenem-resistant Klebsiella pneumoniae bloodstream infections

Objective: To evaluate the efficacy and safety of different antimicrobial regimens in patients with bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Methods: The clinical date of patients with CRKP bloodstream infections were retrospectively analyzed at the First Affiliated Hospital of Zhejiang University Medical College between January 2017 and January 2018. All subjects were separated into three groups based on antibiotics regimens over 72 hours, including meropenem 2.0 g every 8 hours, tigecycline 200 mg as initial dose and 100 mg every 12 hours, and polymyxin B 1.25 mg/kg every 12 hours as salvage treatment of tigecycline. Results: A total of 86 patients were finally recruited, including 14, 52 and 20 patients in groups of meropenem, tigecycline and polymyxin B salvage, respectively. All of the strains were resistant to meropenem and susceptible to tigecycline and polymyxin B initially, while 2 of them became resistant to tigecycline during treatment. The 28-day mortality was significantly higher in meropenem group (13/14) than that in tigecycline group and polymyxin B salvage group (61.5%, 32/52) and (12/20), respectively (P<0.01), while as no significant difference was seen in the last two groups (χ(2)=0.014, P>0.05). The incidences of hepatic impairment [3.8%(2/52) vs. 1/20] and renal dysfunction (0 vs. 1/20) between tigecycline group and polymyxin B salvage group were both comparable (P>0.05). Conclusion: The meropenem-based therapy is not recommended for CRKP-related bloodstream infections. Tigecycline-based therapy is still disappointing despite salvage use of polymyxin B after 72 hours. Hepatic and nephretic toxicities caused by additional polymyxin B are acceptable.

Association between Serum Ferritin Concentration and Perihaematoma Oedema Volume in Patients with Supratentorial Spontaneous Intracerebral Haemorrhage

Background: Stroke (ischaemic &amp; haemorrhagic) is a major cause of mortality and morbidity in the developed as well as in the developing countries. Perihaematoma oedema and haematoma expansion are two important points to be considered when deciding outcome of patients with ICH. Brain damage due to haematoma may be irreversible but the injury from perihaematoma oedema may be reversible. It has been seen that S. ferritin is the most reliable indicator of body iron. Treatment with iron chelators may give better outcome after ICH. Objective: This study was under taken to assess the association between serum ferritin and relative perihaematoma oedema volume. Methodology: This study was a cross sectional observational study that was conducted in the Departments of Neurosurgery &amp; Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) from 1st March, 2014 till 30th September, 2015 on 32 patients (32) who fulfilled the selection criteria were enrolled in this study. Results: In this study, male female ratio was 1:1 and the mean age was 56±15 years. Most of the ICH patients fell in the age group between 41-60 years (53%). During admission, grade-1 (GCS 3- 8) level of consciousness was reported among 45% of patients. All the patients in this study presented with motor deficit that include hemiplegia 20 (62.5%) and hemiparesis 12 (37.5%). Mean value of serum ferritin was found elevated on day 4 (344±406 μg/L) in comparison to day 1 (213.4±123.5μg/ L). Mean value of relative perihaematoma oedema was elevated on day 4 (4±2.7) than day 1 (1.9±1) but it was not statistically significant. Conclusion: In this study after statistical analysis by Pearson’s correlation test we found that there was no significant association between serum ferritin concentration and relative perihaematoma oedema on day-1 and day-4. Bang. J Neurosurgery 2019; 8(2): 77-86

A predictive value of the timed "up and go" test on the fall risk assessment of inpatients with stroke

Objective To explore the predictive value of the timed up and go test on falling of inpatients with stroke, providing objective reference for clinical fall risk evaluation. Methods A total of 62 stroke in patients who were treated in the department of Neurology of the Second Affiliated Hospital of Shantou University Medical College from January 2018 to June 2018 were selected by the convenience sampling method. The timed up and go test was used to record the walking function of stroke inpatients. An ROC curve was used to analyze the efficacy in predicting falls of stroke inpatients. Results The TUGT has demonstrated intraclass correlation coefficient (ICC) value of 0.963 (95%CI 0.938-0.978), and Cronbach alpha coefficient value of 0.983.The difference of the TUGT time between recurrent-fall stroke inpatients [15.69 (13.30, 19.87) seconds] and the patients without a history of falling [12.45 (10.08, 16.26) seconds] was statistically significant (Z=-2.585, P<0.05). Meanwhile, the difference of the TUGT time between male stroke inpatients [13.12 (10.23, 15.35) seconds] and female stroke inpatients [17.09 (12.98, 19.87) seconds] was also statistically significant (Z=-2.297, P<0.05). The TUGT time was significantly (P<0.05) positively correlated both with the fall history (rs=0.331) and gender (rs=0.294) in stroke inpatients. The result of ROC curve showed that the optimal TUGT cut-off point for predicting the fall of male stroke patients was 13.12 seconds with 0.696 for AUC, 78.6% for sensitivity and 68.2% for specificity (P<0.05).While the optimal TUGT cut-off point for predicting the fall of female stroke inpatients was 13.68 seconds with 0.691 for AUC, 73.3% for sensitivity and 65.6% for specificity (P<0.05). Conclusions Although TUGT has good feasibility in stroke inpatients, its predictive value for future falls of stroke inpatients is medium. The assessment and prediction of fall risk should be considered carefully by medical workers so as to reduce the occurrence of falls in stroke inpatients. Key words: Timed up and go test; Stroke; Fall; Prediction

Analysis of occurrence regularity and risk factors of deep venous thrombosis in patients with distal fractures of the knee during perioperative period

Objective To investigate the occurrence of deep venous thrombosis (DVT) in the perioperative period of patients with fracture distal to the knee, so that clinicians have a better understanding of the occurrence of DVT in the perioperative period of the fracture distal to the knee. Methods A retrospective analysis of the clinical data of 365 patients with distal knee fractures who underwent surgery in the Department of Orthopaedics Trauma, Xi′an Jiaotong University Medical College Red Cross Hospital from June 2014 to March 2018 was conducted. There were 213 males and 152 females, aged (45.05±15.24) years, with an age range of 17-83 years. Classification of fracture sites: 177 cases of tibiofibular shaft fracture, 130 cases of ankle fracture, and 58 cases of foot fracture. According to whether thrombosis occurred or not, the patients were divided into thrombotic group and non-thrombotic group before and after operation. There were 66 patients with thrombosis before operation, 299 patients without thrombosis before operation, 88 patients with thrombosis after operation, and 277 patients without thrombosis after operation. The incidence of thrombosis and the location of the thrombus were recorded. The sex, age, fracture site, ASA score, operation time, the time from injury to admission, the time from injury to surgery, intraoperative tourniquet time, intraoperative blood transfusion volume, intraoperative blood loss, intraoperative transfusion volume, hemoglobin volume at admission and 1 day after operation, D-dimer level at admission and 1 day after operation, multiple injuries, chronic hepatitis and medical diseases were analyzed. The measurement data of normal distribution and homogeneity of variance were expressed as mean±standard deviation (Mean±SD), the t test was used for comparison between two groups. The comparison of count data was performed by χ2 test or Fisher exact probability method, and multivariate logistic regression analysis was performed on the risk factors affecting the occurrence of DVT in both lower extremities. Results The preoperative DVT rate was 18.1% (66/365). In patients with thrombosis, distal thrombosis accounted for 93.94% (62/66), and mixed thrombosis accounted for 6.06% (4/66). The incidence of postoperative DVT was 24.1% (88/365). In patients with thrombosis, distal thrombosis accounted for 94.32% (83/88), proximal thrombosis accounted for 1.14% (1/88), and mixed thrombus accounted for 4.55% (4/88). Fracture site, ASA score, operation time, intraoperative tourniquet time, intraoperative blood transfusion volume, intraoperative blood loss, intraoperative transfusion volume were not statistically significant(P>0.05). Age ≥ 40 years (OR=2.691, 95% CI: 1.422-5.093, P=0.002), the time from injury to admission>3 days (OR=1.927, 95%CI: 1.072-3.463, P=0.028) were independent risk factors for DVT formation in fracture distal to the knee before operation. Age ≥ 40 years (OR=3.925, 95% CI: 2.161-7.129, P=0.000), the time from injury to surgery >5 days (OR=1.835, 95%CI: 1.080-3.119, P=0.025), D-dimer level at 1 day after operation (OR=1.191, 95%CI: 1.096-1.293, P=0.000), combined with multiple injuries (OR=1.981, 95%CI: 1.006-3.902, P=0.048), combined with coronary atherosclerotic heart disease (OR =2.692, 95%CI: 1.112-6.517, P=0.028) were independent risk factor for DVT formation after operation for fracture distal to the knee. Conclusions The occurrence of DVT before and after the fracture of the knee is mainly caused by distal thrombosis, and proximal thrombosis also occurs. Those patients aged≥40 years, combined with multiple injuries and coronary heart disease, should focus on preventing the occurrence of DVT. After the injury, the patient is immediately admitted to the hospital for DVT screening, and when the general condition allowed, shortening the preoperative waiting time can reduce the occurrence of DVT. Key words: Fracture; Venous thrombosis; Risk factors

Anatomical distribution and change of distal deep venous thrombosis in patients with hip fracture

Objective To investigate the anatomical distribution and change of distal deep venous thrombosis in patients with hip fracture, to provide evidence for prevention and treatment of deep vein thrombosis in patients with hip fracture and lower limb deep vein ultrasound examinatio. Methods The clinical data of 383 patients with hip fractures who were admitted in Department of Orthopaedics Trauma, Xi′an Jiaotong University Medical College Red Cross Hospital from July 2014 to April 2018 were analyzed retrospectively. There were 122 males and 261 females, the age range was 17 to 94 years, the median was 78 years, and the interquartile range was 12 years. There were 154 cases of femoral neck fracture, 208 cases of femoral intertrochanteric fracture, and 21 cases of femoral subtrochanteric fracture. Deep venous thrombosis was assessed by ultrasonography before and 3-5 days after operation, and the anatomical location and changes of deep vein thrombosis were analyzed. The skewed distribution data were represented by the median and interquartile range. The proportion of the number of deep venous thrombosis case in the anatomical position of the lower extremities was expressed as a percentage. Results Of the 383 patients with hip fracture who had distal deep venous thrombosis before surgery, isolated distal deep vein thrombosis (IDDVT) accounted for 89.30% (342/383), and multivessel thrombosis accounted for 10.70% (41/383). In IDDVT, intermuscular venous thrombosis was the most common, and no anterior venous thrombosis occurred. In multivessel thrombosis, two or three of the intermuscular vein, the posterior tibial vein, and the iliac vein were more common. Twenty-eight (7.31%) patients had distal thrombus extension to the proximal end (including 21 cases involving the iliac vein and 7 cases involving the superficial femoral vein), IDDVT accounted for 61.88% (237/383). The involvement of multiple venous thrombosis accounted for 16.19% (62/383), 62.40%(239/383) of the distal thrombus position did not change, and 14.62%(56/383) of the distal thrombus disappeared. Conclusions For patients with hip fracture, the intermuscular vein is the most common site of distal deep venous thrombosis, ultrasound examination of anterior tibial vein is not necessary. Under anticoagulation, 7.31% of distal deep venous thrombosis may extend to the proximal and 14.62% of distal deep venous thrombosis disappear. For patients with hip fracture complicated with distal deep venous thrombosis in hospital, patients without contraindication of anticoagulation should be treated with anticoagulation at an early stage to prevent the proximal progression or fall off of thrombosis and reduce the risk of distal deep venous thrombosis. Key words: Hip; Venous thrombosis; Dissection

LIP FORENSICS; CHEILOSCOPIC PATTERN AMONG POPULATION OF PUNJAB, PAKISTAN.

Introduction: Personal identity is an attribute of a mankind which makes him or her unique. Cheiloscopy is one of the sciences which is used to study and examine the lip prints pattern in order to establish the personal identity in Forensic Medicine. Objectives: To categorize lip patterns in female population of different divisions of Punjab, Pakistan according to Suzuki and Tsuchihashi’s classification. Study Design: Descriptive, Cross-sectional study. Setting: The present study was conducted on 357 female students of 1st, 2nd and 3rd year of University Medical and Dental College, Faisalabad in the department of Forensic Medicine and Toxicology. Period: March-June, 2018. Methods: After obtaining informed consent students were asked to stand erect and their lip prints were taken on the glass slide. Next carbon black powder was dispensed on the slide and the latent lip print pattern was obtained. The slide was preserved by using cellophane tape and lip prits patterns were scanned. These patterns were then categorized according to Suzuki and Tsuchihashi’s classification by using Software Adobe Photoshop version 6.0. Results: The results showed that most participants were from central Punjab (70%) followed by Southern Punjab (19%), Western Punjab (9.6%) and Northern Punjab (1.4%). The most common lip print pattern was Type I (66%), second was Type II (17.3%), then Type IV (7.1%), after that Type III (5.1%), Type Iʹ(2.5%) &amp; last was Type V (1.7%). Conclusion: The most common lip print pattern in females of Punjab, Pakistan is Type I while the least common is Type V.

Compliance with the ERAS Protocol and 3-Year Survival After Laparoscopic Surgery for Non-metastatic Colorectal Cancer

IntroductionEnhanced recovery after surgery (ERAS) pathways have been proven to enhance postoperative recovery, reduce morbidity, and reduce length of hospital stay after colorectal cancer surgery. However, despite the benefits of the ERAS program on short-term results, little is known about its impact on long-term results.ObjectiveThe aim of the study was to determine the association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer.Material and MethodologyBetween 2013 and 2016, 350 patients underwent laparoscopic colorectal cancer resection in the 2nd Department of General Surgery, Jagiellonian University Medical College, and were enrolled for further analysis. The relationship between the rate of compliance with the ERAS protocol and 3-year survival was analyzed according to the Kaplan–Meier method with log-rank tests. Patients were divided into two groups according to their degree of adherence to the ERAS interventions: Group 1 (109 patients), < 80% adherence, and Group 2 (241 patients), ≥ 80% adherence. The primary outcome was overall 3-year survival. The secondary outcomes were postoperative complications, length of hospital stay, and recovery parameters.ResultsThe groups were similar in terms of demographics and surgical parameters. The median compliance to ERAS interventions was 85.2%. The Cox proportional model showed that AJCC III (HR 3.28, 95% CI 1.61–6.59, p = 0.0021), postoperative complications (HR 2.63, 95% CI 1.19–5.52, p = 0.0161), and compliance with ERAS protocol < 80% (HR 3.38, 95% CI 2.23–5.21, p = 0.0102) were independent predictors for poor prognosis. Additionally, analysis revealed that adherence to the ERAS protocol in Group 2 with ≥ 80% adherence was associated with a significantly shorter length of hospital stay (6 vs. 4 days, p < 0.0001), a lower rate of postoperative complications (44.7% vs. 23.3%, p < 0.0001), and improved functional recovery parameters: tolerance of oral diet (53.4% vs. 81.5%, p < 0.0001) and mobilization (77.7% vs. 96.1%, p < 0.0001) on the first postoperative day.Conclusions and RelevanceThis study reports an association between adherence to the ERAS protocol and long-term survival after laparoscopic colorectal resection for non-metastatic cancer. Lower adherence to the protocol, independent from stage of cancer and postoperative complications, was an independent risk factors for poorer survival rates.

Impact of Premature Greying of Hair on Socio-cultural Adjustment and Self-esteem among Medical Undergraduates in Foundation University, Islamabad.

IntroductionGreying of hair is an inevitable phenomenon that occurs commonly as a person ages. It usually occurs in the fourth decade regardless of gender but now a days, even people in their early twenties can experience premature greying. The objective of our study was to determine the frequency of premature greying of hair and its impact on the socio-cultural spheres of life and self-esteem of medical students.MethodologyIt is a descriptive cross-sectional study conducted at Foundation University Medical College (FUMC) from January to February 2017. All medical students of FUMC who gave their consent were included in the study sample. Students who were absent or unwilling to participate were excluded. Data was collected through a self-administered questionnaire, which was then analysed using SPSS version 17 (SPSS Inc., Chicago, IL).ResultsOut of 673 students, 210 (31.2%) suffered from premature greying of hair. The prevalence was higher among females (155/73.8%) as compared to males (55/26.2%). There was a statistical difference in perception of both the genders, regarding those with premature greying of hair trying to hide it (p-value = 0.000), premature greying of hair as contagious (p-value = .009) and the affected looking older than their actual age (p-value = 0.036).ConclusionThe study showed that premature greying affected the socio-cultural spheres of students’ lives. Females were more prone to developing premature greying of hair. Genetics also play a significant role in the phenomenon. No positive correlation was found by using Rosenberg Self-esteem scale.

Prognostic Value of Pre-Treatment Neutrophil-to-Lymphocyte Ratio and Platelet in Patients with Operable Head and Neck Squamous Cell Carcinoma

Background: Peripheral blood inflammation factor neutrophil-lymphocyte Ratio (NLR), platelet and nutritional factor albumin (ALB) have recently been proposed as prognostic markers in solid tumors. The current study the impact of those hematological parameters and oncologic outcomes in patients with operable head and neck squamous carcinoma cancer (HNSCC) using database approach were evaluated. Methods: 198 patients with oropharyngeal, hypopharyngeal and laryngeal cancers receiving multimodality protocols between 2012 and 2014 were included. Neutrophil, lymphocyte, platelet and albumin from the last phlebotomy before treatment were identified. Patients were risk-stratified and were tested for association with survival and disease-control outcomes. Results: 5-year LRC were decreased (p=0.004, respectively) for 140 patients with NLRpre-treatment 248×109/L were better among tested models. On Bayesian information criteria (BIC) analysis, the optimal prognostic model was then used to develop nomograms predicting 3- and 5-year locoregional recurrence (LRC). External validity evaluated by studying another 57 patients from other hospital confirmed the reliability of prediction model. Conclusion: Pre-treatment NLR elevation and platelet >248×109/L are promising predictors of prognosis in patients with operable HNSCC. The analyses performed show that pre-treatment hematological inflammatory markers and platelet-based Nomograms provide a distinct risk stratification. Further works should be complete to elucidate the utility of anti-inflammatory and anti- platelet treatments in modifying risk in peri-operation HNSCC patients. Funding Statement: This study is sponsored by grants from Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (Grant No.2019336033). Medical Health Science Project of Hangzhou (Grant No. OO20190775). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was in accordance with Declaration of Helsinki and approved by the Research Ethic Committees of Affiliated Sir Run Run Shaw Hospital, Zhejiang University medical college and The Second Affiliated Hospital of Nanchang University Medical College. Both the institutional review board approved data extraction was performed from an existing HNSCC.

Diagnostic test validity of CT-scan for detection of liver abscess

Background: Detection of hepatic abscess is very crucial for the management of the patient. Objective: The purpose of the present study was to validate the diagnostic ability of CT-scan during detection of hepatic abscess. Methodology: This cross-sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of January 2006 to December 2007 for a period of two (02) years. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of hepatic abscess with the presentation of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 suspected cases of hepatic abscess patients were recruited for this study. Maximum patients were within 56 to 65 years age range. 15 (30%) patients were within 56 to 65 years age range. In case of hepatic abscess, 11 patients were diagnosed as having hepatic abscess by CT and confirmed by histopathological evaluation. One patient was diagnosed other lesion by CT and confirmed by histopathology. Of 38 patients of other lesions, which were confirmed by CT, two confirmed as hepatic abscess and 36 were other lesions by histopathology. The sensitivity of CT scan in the diagnosis of hepatic abscess was 84.6% (95% CI 54.55% to 98.08%). However specificity was 97.3% (95% CI 85.84% to 99.93%). The accuracy was 94.0% (95% CI 83.45% to 98.75%). The area under the curve value was 0.09 (95% CI 0.000 to 0.211) which was statistically significant. Conclusion: In conclusion CT-scan has a very high specificity with sensitivity for the detection of hepatic abscess.

Protocol for a prospective observational study on the association of variables obtained by contrast-enhanced ultrasonography and sepsis-associated acute kidney injury

IntroductionSepsis commonly results in acute kidney injury (AKI), whereas about 50% of AKI cases are due to sepsis. Sepsis-associated acute kidney injury (SA-AKI) increases morbidity and mortality especially among critically...

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jimmy K. LeeJimmy K. LeeDr Jimmy K. Lee specializes in laser vision correction surgery. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, all forms of corneal transplantation, and limbal stem cell transplantation. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Mian is a Professor in ophthalmology and visual sciences at University of Michigan/Kellogg Eye Center and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. His practice is focused in cornea and refractive surgery and research interests include corneal transplantation techniques, ocular graft versus host disease, and eye banking. He is the Vice Chair for Clinical Sciences and Learning and has been director of the residency training program since 2004. In 2003 and 2012, he received the Bergstrom Faculty Teaching Award presented by ophthalmology residents. He received the Straatsma award for resident education in 2017. He serves on the Residency Review Committee for Ophthalmology, Accreditation Board for the Eye Bank Association of America, as the senior medical director of Eversight Michigan Eye bank, and is the past-president of the Program Director's Council of the Association of University Professor in Ophthalmology.