Systematic review of the use of endo-luminal topical negative pressure in oesophageal leaks and perforations

Summary

Topical negative pressure is widely used in the management of superficial wounds. The use of this technology in the management of oesophageal perforations is becoming increasingly common. This systematic review aims to capture available evidence about its use in this setting. Medline and Embase were searched using MeSH terms and free text: esophageal perforation; esophageal injury; vacuum assisted closure; vacuum therapy device; esophagus; wounds penetrating; esophageal perforation; wound healing; negative pressure wound therapy. Searches were carried out between April and November 2015. Case series, cohort trials and controlled trials were included. Additional studies were found by hand searching reference lists. Eleven studies met the inclusion criteria with 180 patients. Nine of the studies were case series and two were retrospective comparisons of negative pressure with stents or clips. Healing of the perforation occurred in 163/179 patients and the overall mortality was 12.8%. Compared with published data on mortality from oesophageal perforation, the application of negative pressure appears to be beneficial. The studies are, however, limited to case series and retrospective cohort studies. The number of patients in each study is small and in the absence of randomized trials demonstrating a lack of bias firm conclusions cannot be made.

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Comparison of three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy in the treatment of cervical esophageal carcinoma

Summary

The aim of this study was to evaluate the effectiveness and toxicities of three-dimensional conformal radiation therapy (3DCRT), intensity-modulated radiation therapy (IMRT), and volumetric-modulated arc therapy (VMAT) in patients with cervical esophageal cancer. Specifically, we asked whether technological advances conferred an advantage with respect to the clinical curative effect. Seventy-eight patients with cervical esophageal cancer treated with definitive radiotherapy with or without concomitant chemotherapy at our institution between 2007 and 2014 were enrolled in the study: 26 received 3DCRT, 30 were treated with IMRT, and 22 underwent VMAT. Kaplan–Meier analysis and the Cox proportional hazard model were used to analyze overall survival (OS) and failure-free survival (FFS). Treatment-related toxicity was also assessed. For all patients, the 2-year OS and FFS rates were 56.2 and 53.9%, respectively. The 2-year OS for the 3DCRT, IMRT, and VMAT groups was 53.6, 55.6, and 60.6%, respectively (P = 0.965). The corresponding 2-year FFS rates were 49.5, 56.7, and 60.1% (P = 0.998). A univariate analysis of the complete response to treatment showed an advantage of treatment modality with respect to OS (P < 0.001). The development of acute hematologic toxicity was not significantly different among the three groups. The survival rates of patients treated with IMRT and VMAT were comparable to the survival of patients administered 3DCRT, while lower lung mean dose, V20, maximum dose of brachial plexus and spinal cord. Grade 1 radiation pneumonitis occurred significantly less in patients treated with IMRT and VMAT than with 3DCRT (P = 0.011). A complete response was the most important prognostic factor of the patients with cervical esophageal cancer.

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Nasogastric decompression following esophagectomy: a systematic literature review and meta-analysis

Summary

Routine use of nasogastric tubes for gastric decompression has been abolished in nearly all types of gastro-intestinal surgery after introduction of enhanced recovery after surgery programs. However, in esophagectomy the routine use of nasogastric decompression is still a matter of debate. To determine the effects of routine nasogastric decompression following esophagectomy compared with early or peroperative removal of the nasogastric tube on pulmonary complications, anastomotic leakage, mortality, and postoperative recovery. A systematic literature review and meta-analysis of studies comparing early or peroperative versus late removal of nasogastric tubes. A total of seven comparative studies were included (n = 608). In two randomized trials, and one retrospective cohort study, peroperative removal of the nasogastric tube was compared with routine nasogastric decompression. In one randomized trial early removal of the nasogastric tube (on postoperative day 2) was compared with removal of the nasogastric tube on the 6th–10th postoperative day. In the remaining three trials a fast-track protocol without a nasogastric tube was compared with conventional care with a nasogastric tube during the first postoperative days. Peroperative or early removal of the nasogastric tube did not result in a significantly different rate of anastomotic leakage, pulmonary complications or mortality in individual studies, nor in the meta-analysis. In the meta-analysis, hospital stay was significantly shorter with peroperative or early removal of the nasogastric tube when all studies were included, but not when the meta-analysis was limited to randomized trials. This systematic review did not find a difference in adverse outcomes between nasogastric decompression or no nasogastric decompression following esophagectomy.

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Searching for the most effective thyrotropin (TSH) threshold to rule-out autonomously functioning thyroid nodules in iodine deficient regions

Abstract

The purpose of this study is to evaluate the distribution of thyrotropin (TSH) values in patients with autonomously functioning thyroid nodules and to set a TSH threshold above which thyroid scintigraphy would be obviated. Four hundred fifty one patients were included in the present study. Inclusion criteria were age > 18 years, TSH levels between 0.40 and 4.0 mIU/L, detection of a single solid or predominantly solid thyroid nodule >10 mm in the longest diameter. Thyroid ultrasound and thyroid scintigraphy with ^99mTc-pertechnetate were performed concurrently in all patients. Among 451 enrolled patients, 173 (38 %) had an autonomously functioning thyroid nodules, of which 137 (79 %) with a normal TSH level. Demographic data and nodules' volume were not significantly different in patients with autonomously functioning thyroid nodules and non-functioning nodules, respectively. However, TSH levels were nonetheless significantly lower in patients with autonomously functioning thyroid nodules compared to those with non-functioning nodules (p < 0.001). Adopting a TSH cutoff level at 2.38 mUI/L, all autonomously functioning thyroid nodules were correctly identified (i.e., 100 % sensitivity) with a 100 % negative predictive value. Our study showed a very high prevalence of autonomously functioning thyroid nodules in mildly iodine-deficient regions and confirmed that serum TSH is not an effective screening test to diagnose an autonomously functioning thyroid nodules. Our data add arguments in favor of the first-line use of thyroid scintigraphy to assess thyroid nodules, at least in iodine deficient areas. As all scintigraphically detected autonomously functioning thyroid nodules had a TSH level below 2.38 mUI/L, a thyroid scintigraphy should be omitted when higher TSH values are found in patients carrying a thyroid nodule.

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Distinct subpopulations of hepatitis C virus infectious cells with different levels of intracellular hepatitis C virus core protein

Publication date: Available online 14 September 2016
Source:The Kaohsiung Journal of Medical Sciences
Author(s): Shu-Chi Wang, Jeng-Fu Yang, Chao-Ling Wang, Chung-Feng Huang, Yu-Yin Lin, Yi-You Chen, Chung-Ting Lo, Po-Yen Lee, Kuan-Ta Wu, Chia-I. Lin, Meng-Hsuan Hsieh, Hung-Yi Chuang, Chi-Kung Ho, Ming-Lung Yu, Chia-Yen Dai
Chronic infection by hepatitis C virus (HCV) is a major risk factor for the development of hepatocellular carcinoma (HCC). Despite the clear clinical importance of virus-associated HCC, the underlying molecular mechanisms remain largely unclarified. Oxidative stress, in particular, DNA lesions associated with oxidative damage, plays a major role in carcinogenesis, and is strongly linked to the development of many cancers, including HCC. However, in identifying hepatocytes with HCV viral RNA, estimates of the median proportion of HCV-infected hepatocytes have been found as high as 40% in patients with chronic HCV infection. In order to explore the gene alternation and association between different viral loads of HCV-infected cells, we established a method to dissect high and low viral load cells and examined the expression of DNA damage-related genes using a quantitative polymerase chain reaction array. We found distinct expression patterns of DNA damage-related genes between high and low viral load cells. This study provides a new method for future study on virus-associated gene expression research.



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The Multiscale Entropy: guidelines for use and interpretation in brain signal analysis

Publication date: Available online 14 September 2016
Source:Journal of Neuroscience Methods
Author(s): Julie Courtiol, Dionysios Perdikis, Spase Petkoski, Viktor Müller, Raoul Huys, Rita Sleimen-Malkoun, Viktor K. Jirsa
BackgroundMultiscale Entropy (MSE) estimates the predictability of a signal over multiple temporal scales. It has been recently applied to study brain signal variability, notably during aging. The grounds of its application and interpretation remain unclear and subject to debate.MethodWe used both simulated and experimental data to provide an intuitive explanation of MSE and to explore how it relates to the frequency content of the signal, depending on the amount of (non)linearity and stochasticity in the underlying dynamics.ResultsThe scaling and peak-structure of MSE curves relate to the scaling and peaks of the Power Spectrum in the presence of linear autocorrelations. MSE also captures nonlinear autocorrelations and their interactions with stochastic dynamical components. The previously reported crossing of young and old adults' MSE curves for EEG data, appears to be mainly due to linear stochastic processes, and relates to young adults' EEG dynamics exhibiting a slower time constant.Comparison with existing methodsWe make the relationship between MSE curve and Power Spectrum as well as with a linear autocorrelation measure, namely Multiscale Root-Mean-Square-Successive-Difference, more explicit. MSE allows gaining insight into the time-structure of brain activity fluctuations. Its combined use with other metrics could prevent any misleading interpretations with regard to underlying stochastic processes.ConclusionsAlthough not straightforward, when applied to brain signals, the features of MSE curves can be linked to their power content and provide information about both linear and nonlinear autocorrelations that are present therein.



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The path to economic independence among survivors of intimate partner violence: A critical review of the literature and courses for action

Publication date: Available online 14 September 2016
Source:Aggression and Violent Behavior
Author(s): Einat Peled
Public policy encourages women, including survivors of intimate partner violence (IPV), to develop economic independence. However, a critical review of the literature in this field reveals that IPV survivors face unique obstacles in doing so: active and violent intervention by the perpetrator; damage to the survivor's health due to prolonged subjection to violence; and structural obstacles. A background of gendered violence, low socioeconomic status, and belonging to a marginalized ethnic or racial group, may further intersect with the direct and indirect influences of that violence, resulting in even greater obstacles to the development of economic independence. The article concludes with a discussion of how existing intervention programs for developing economic independence among survivors of IPV meet those obstacles, and a framework for intervention in this domain. (126 words)



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