REVIEW | doi:10.20944/preprints202111.0500.v1
Subject: Medicine & Pharmacology, Veterinary Medicine Keywords: Abdominal wall; Transversus abdominis plane block; Comparative anatomy; Animal models
Online: 26 November 2021 (10:47:30 CET)
With the increased use of simulation based training using animal models for the education of surgical and anaesthetic techniques, an increased understanding of the anatomy of such models and how they compare to humans is required. The transversus abdominis plane block is a regional anaesthetic technique that requires an understanding of the abdominal wall anatomy along with proficient ultrasound use. The current review aims to compare the anatomy of the abdominal wall across species, particularly focussing on the pertinent differences within the class of mammals, and secondarily, it aims to address the implications of these differences for simulation based training of the transversus abdominis plane block. To achieve this, the PubMed, Web of Science and Google Scholar databases were searched for relevant literature. The mammalian abdominal wall differs in its musculature, vasculature or innervation from that of amphibians, birds or reptiles, however, among species of mammals, the structure of the abdominal wall follows a similar framework. Particular differences among mammals include the additional muscular layer of the panniculus carnosus found in most mammals other than humans, the variable arterial origins and dominant vascular supply of the abdominal wall and the number of thoracolumbar nerves innervating the abdominal wall. When using animal models for simulation based training, the pig is recommended for the transversus abdominis plane block given its closely homologous abdominal wall structure, availability and larger comparative size.
ARTICLE | doi:10.20944/preprints202205.0145.v1
Subject: Medicine & Pharmacology, Cardiology Keywords: abdominal aorta; arterial embolism; B-Flow sonography; contrast enhanced ultrasound; endovascular aortic repair; flashlight sign; peripheral arteries; wall adherent floating structures
Online: 11 May 2022 (03:44:41 CEST)
This study aimed on evaluating the potential diagnostic value of a novel, sonographic, B-Flow Imaging (BFI)-based sign (“flashlight sign”, FLS) for the detection of wall-adherent, floating arterial structures (WAFAS). The FLS, characterized by a fast moving, very bright, intraluminal signal was detected in 28 patients with WAFAS. We divided this cohort into three subgroups, depending on the affected vascular segments: (1) peripheral arteries (n = 10), (2) native abdominal aorta (n = 8), and (3) abdominal aorta after endovascular aortic repair (EVAR; n = 10). Clinical characteristics were analyzed and BFI-findings were compared with contrast enhanced ultrasound (CEUS) and computed tomography angiography (CTA). Seven patients (25%) suffered from arterial embolism downstream to the FLS (EVAR, n = 4; native abdominal aorta, n = 1; peripheral arteries, n = 2). WAFAS of the abdominal aorta (native or after EVAR), as indicated by the FLS, were visible by CEUS and CTA in 60% and 93.3%, respectively. Based on the so far largest cohort of patients with WAFAS, we propose a clinically useful, BFI-based sonographic sign for detection of these so far underrated arterial pathologies in the abdominal aorta and the peripheral arteries.
ARTICLE | doi:10.20944/preprints201801.0100.v1
Subject: Medicine & Pharmacology, Other Keywords: intra-abdominal pressure; abdominal compartment syndrome; pressure sensor; negative pressure wound therapy; open abdomen;
Online: 11 January 2018 (09:17:10 CET)
1) Introduction: Negative pressure wound therapy (NPWT) is a frequently applied open abdomen (OA) treatment. There are only a few experimental data supporting this method and describing the optimal settings and pressure distribution in the abdominal cavity during this procedure. The aim of our study was to evaluate pressure values at different points of the abdominal cavity during NPWT in experimental abdominal compartment syndrome (ACS) animal model. 2) Methods: In this study (permission Nr. 13/2014/UDCAR) 27 Hungahib pigs (15.4- 20.2 kg) were operated. ACS was generated by implanting a plastic bag in the abdomen through mini-laparotomy and filled with 2100- 3300 ml saline solution (37 C°) to an intraabdominal pressure (IAP) of 30 mmHg. After 3 hours, NPWT (Vivano Med ® Abdominal Kit, Paul Hartmann AG, Germany) or Bogota bag was applied. NPWT group was divided into -50, -100 and 150 mmHg suction group. Pressure distribution to the abdominal cavity was monitored at 6 different points of the abdomen via a multichannel pressure monitoring system. 3) Results: The absolute pressure levels were significantly higher above than below the layer. The values of the pressure were similar in the midline than laterally. Amongst the bowels, the pressure values changed periodically between 0 and -12 mmHg which might be caused by the peristaltic movements. 4) Conclusions: The porcine model of the present study seems to be well applicable for investigating ACS and NPWT. It was possible to provide valuable for clinicians. The pressure was well distributed by the protective layer to the lateral parts of the abdomen and this phenomenon did not change considerably during the therapy.
ARTICLE | doi:10.20944/preprints202210.0128.v1
Subject: Medicine & Pharmacology, Nutrition Keywords: Rural Health; Obesity abdominal; Metabolic syndrome
Online: 10 October 2022 (13:59:16 CEST)
(1) Background: Metabolic syndrome is associated with cardiovascular complications. Therefore, this study aims to establish cut points for the conicity index based on the components of the metabolic syndrome and to associate it with characteristics sociodemographic, food consumption and occupational factors in Brazilian rural workers; (2) Methods: Cross-sectional study carried out with farmers. The receiver operating characteristic curve was calculated and the cutoff points for the conicity index were identified by the area under the curve, sensitivity and specificity. The variables included in the binary logistic regression analysis were selected by considering p < 0.20 in the bivariate test; (3) Results: The cut points were similar in females according to both criteria, resulting in a single cut-off of 1.269. In males, the cut points showed differences, resulting in 1.272 according to the NCEP-ATP III and 1.252 according to the IDF. We have shown that younger people, those who work more than 40 hours a week and the lowest contribution of culinary ingredients are associated with increased odds of abdominal obesity. While the consumption of the products they sell or produce decreases these chances; (4) Conclusions: The conicity index showed high discriminatory power for the identification of abdominal obesity in rural workers.
REVIEW | doi:10.20944/preprints202103.0227.v1
Online: 8 March 2021 (13:54:28 CET)
Worldwide, hernia repair represents one of the most frequent surgical procedures encompassing a global market valued at several billion dollars. This type of surgery usually requires the implantation of a mesh that needs the appropriate chemical, physical and biological properties for the type of repair. This review thus presents a description of the types of hernias, current hernia repair methods, and the state of the art of prosthetic meshes for hernia repair providing the most important meshes used in clinical practice by surgeons working in this area classified according to their biological or chemical nature, morphology and whether bioabsorbable or not. We emphasise the importance of surgical site infection in herniatology, how to deal with this microbial problem, and we go further into the future research lines on the production of advanced antimicrobial meshes to improve hernia repair and prevent microbial infections, including multidrug-resistant strains. A great deal of progress has been made in this biomedical field in the last decade. However, we are still far from an ideal antimicrobial mesh that can also provide excellent integration to the abdominal wall, mechanical performance, low visceral adhesion and minimal inflammatory or foreign body reactions, among many other problems.
ARTICLE | doi:10.20944/preprints202102.0510.v1
Subject: Medicine & Pharmacology, Allergology Keywords: trauma; pancreas; abdominal injury; head injury; polytrauma
Online: 23 February 2021 (11:03:14 CET)
Background: We aimed to study the frequency, management, and outcomes of patients with blunt pancreatic trauma. Methods: We reviewed the medical records for all patients admitted with pancreatic injuries between 2011 and 2017 at the only level 1 trauma center in the country. Results: There were 71 patients admitted with pancreatic trauma (0.6% of trauma admissions and 3.4% of abdominal injury admissions) with a mean age of 31 years. Sixty-two patients had pancreatic injury grade I-II and 9 had grade III-IV. Thirty-eight percent had GCS <9 and 73% had ISS >16. The level of pancreatic enzymes was significantly proportional to the grade of injury. Over half of patients required a laparotomy, of them 12 patients had an intervention on the pancreas. Eight patients developed complications related to pancreatic injuries ranging from pancreatitis to pancreatico-cutaneous fistula while 35% developed hemorrhagic shock. Mortality was 31% and regardless of the grade of injury, the mortality was associated with high ISS, low GCS and presence of hemorrhagic shock. Conclusion: Pancreatic injuries following blunt trauma are rare and the injured subjects are usually young male. However, most injuries are of low-grade severity. This study shows that shock, higher ISS and lower GCS are associated with worse in-hospital out-comes. Non-operative management may suffice in patients with lower grade injuries, which may not be the case in patients with higher grade injuries unless carefully selected
ARTICLE | doi:10.20944/preprints202104.0237.v1
Subject: Medicine & Pharmacology, Allergology Keywords: waist circumstance; obesity; abdominal obesity; glioma; risk factors
Online: 8 April 2021 (12:13:07 CEST)
The association between obesity and the risk of gliomas remains unclear. We sought to evaluate the potential association between general and abdominal obesity and the risk of gliomas based on a nationwide population-based cohort study of Koreans. Using data from the Korean National Health Insurance System cohort, 6,833,744 people older than 20 years who underwent regular national health examination in both 2009 and 2011 were followed until the end of 2017. We documented 4,771 glioma cases based on an ICD-10 code of C71 during the median follow-up period of 7.30 years. Individuals with a body mass index (BMI) ≥ 25.0 kg/m2 were at significantly higher risk of gliomas than those with a BMI < 25.0 kg/m2 (HR 1.08 CI 1.02-1.15). Individuals with a waist circumference (WC) ≥ 90 cm (males)/85 cm (females) also had a significantly higher risk of gliomas than those with a WC < 90 cm (males)/85 cm (females) (HR 1.16 CI 1.09-1.24). In the group with a BMI ≥ 25.0 kg/m2, individuals with abdominal obesity were at significantly higher risk of gliomas (HR 1.18 CI 1.09-1.27) than those without abdominal obesity. The role of abdominal obesity in this association was stronger in women than in men. To our knowledge, this is the first demonstration that obese people may be at higher risk of gliomas, especially centrally obese people from an Asian population with a BMI ≥ 25.0 kg/m2. Loss of visceral fat in people with abdominal obesity may reduce their risk of gliomas.
ARTICLE | doi:10.20944/preprints201608.0082.v1
Subject: Physical Sciences, Other Keywords: hitting; ultrasonography; lateral dominance; abdominal muscle; back muscle
Online: 8 August 2016 (14:36:41 CEST)
The purpose of the present study was to examine the relationships between bat swing speed (BSS) and muscle thickness and lateral asymmetry of the trunk and limbs in collegiate baseball players. Twenty-four collegiate baseball players participated in this study. The maximum BSS in hitting a teed ball was measured using a motion capture system. The muscle thicknesses of the trunk (upper abdominal rectus, central abdominal rectus, lower abdominal rectus, abdominal wall, and multifidus lumborum), upper limb, and lower limb were measured using a B-mode ultrasonography. Lateral asymmetry between each pair of muscles was determined as the ratio of the thickness of the dominant side to that of the non-dominant side. Significant positive correlations were observed between BSS and muscle thicknesses of the abdominal wall and multifidus lumborum on the dominant side (r = 0.426 and 0.431, respectively; p < 0.05), while nearly significant positive correlations were observed between BSS and muscle thicknesses on the non-dominant side. No significant correlations were found between BSS and lateral asymmetry of all muscles. These findings indicate the importance of the trunk muscles for bat swing, and the lack of association between BSS and lateral asymmetry of muscle size.
ARTICLE | doi:10.20944/preprints202209.0253.v1
Subject: Medicine & Pharmacology, Pathology & Pathobiology Keywords: Abdominal aortic aneurysm; Type I interferon receptor, Leukocytes; Angiogenesis
Online: 19 September 2022 (02:08:07 CEST)
Objective: Type I interferon receptor (IFNAR) signaling contributes to several autoimmune and vascular diseases such as atherosclerosis and stroke. The purpose of this study was to assess the influence of IFNAR1 deficiency on the formation and progression of experimental abdominal aortic aneurysms (AAAs). Methods: AAAs were induced in type I interferon receptor subunit 1 (IFNAR1) deficient and wild type control male mice via intra-infrarenal aortic infusion of porcine pancreatic elastase. Immunostaining for IFNAR1 was evaluated in experimental and clinical aneurysms. The initiation and progression of experimental AAAs was assessed via ultrasound imaging prior to (day 0) and 3-, 7-, and 14-days following elastase infusion. Aneurysmal histopathology was analyzed at sacrifice. Results: Increased aortic medial and adventitial IFNAR1 expression was present in both clinical AAAs harvested at surgery and experimental AAAs. Following AAA initiation, wild type mice experienced progressive, time-dependent infrarenal aortic enlargement. This progression was substantially attenuated in IFNAR1 deficient mice. On histological analyses, medial elastin degradation, smooth muscle cell depletion, leukocyte accumulation and neoangiogenesis were markedly diminished in IFNAR1 deficient as compared to wild type mice. Conclusion: IFNAR1 deficiency limited experimental AAA progression in response to intra-aortic elastase infusion. Combined with clinical observations, these results suggest a regulatory role for IFNAR1 activity in AAA pathogenesis.
REVIEW | doi:10.20944/preprints201810.0636.v1
Subject: Medicine & Pharmacology, Other Keywords: abdominal aortic aneurysm, risk factors, observational studies, meta-analysis
Online: 26 October 2018 (15:28:44 CEST)
Abdominal aortic aneurysm (AAA) represents an important public health problem with a prevalence between 1.3% and 12.5%. Several population-based randomized trials have evaluated ultrasound screening for AAA providing evidence of a reduction in aneurysm-related mortality in the screened population. The aim of our study was to perform a systematic review and meta-analysis of the risk factors for AAA. We conducted a systematic review of observational studies and we performed a meta-analysis that evaluated the following risk factors: gender, smoking habits, hypertension, diabetes mellitus, Coronary Artery Disease and family history of AAA. Abdominal aortic aneurysm prevalence is higher in smokers and in males. It is important to underline that all countries, where AAA screening was set up, had high income level and the majority belong to Western Europe (United Kingdom, Sweden, Italy, Poland, Spain and Belgium). Abdominal aortic aneurysm screening is fundamental for public health. It would avoid deaths, ruptures, and emergency surgical interventions if abdominal aortic aneurysm was diagnosed early in the population target for screening.
ARTICLE | doi:10.20944/preprints202205.0127.v1
Subject: Medicine & Pharmacology, Pathology & Pathobiology Keywords: hypertension; obesity; body composition; intra-abdominal fat; sleep apnea; obstructive
Online: 10 May 2022 (04:45:21 CEST)
Background: Elevated fasting plasma glucose and visceral fat area (VFA) is highly prevalent in obese adults. This study investigated the associations between systemic arterial hypertension (SAH) and laboratory, anthropometric, heart rate variability (HRV), and obstructive sleep apnea markers. Methods: Cross-sectional study with 95 obese patients treated at Obesity Treatment and Surgery Center, located in Salvador, BA, Brazil. SAH data were obtained from electronic medical records of patients. To evaluate the association of SAH with the predictor variables, the sample was stratified in Normotense Group (NG) and Hypertensive Group (HG), and laboratory markers, body composition, polysomnography data, and HRV were measured. Results: The average age of the NG was 36.3 ± 10.1 and HG 40.4 ± 10.6 years, 73.7% were women in the NG and 57.9% in HG; 82.4% in HG had insulin resistance. In the multivarious logistics regression model with adjustments age, sex, height, and oxyhemoglobin saturation, SAH was inversely associated with fasting plasma glucose mg/dL (odds ratio [OR] = 0.96; 95% interval confidence [CI] = 0.92 - 0.99) and VFA cm2 (OR = 0.98; 95% CI = 0.97 - 0.99). The area under curve the VFA was 0.728; CI 95% (0.620 - 0.836) and fasting plasma glucose 0.693; CI 95% (0.582 - 0.804). Conclusions: Lower VFA and fasting plasma glucose concentrations were inversely associated with SAH. These results indicate opportunities to improve the outcome in obese patients through counseling and clinical interventions.
ARTICLE | doi:10.20944/preprints201812.0199.v1
Subject: Engineering, Biomedical & Chemical Engineering Keywords: Abdominal Aortic Aneurysm; FSI; CFD; haematocrit; pulsatile flow; non-Newtonian
Online: 17 December 2018 (15:50:54 CET)
The Abdominal Aortic Aneurysm (AAA) is a local dilation of the abdominal aorta and it is a cause for serious concern because of the high mortality associated with its rupture. Consequently, the understanding of the phenomena related to the creation and the progression of an AAA is of crucial importance. In this work the complicated interaction between the blood flow and the AAA wall is numerically examined using a fully coupled Fluid-Structure Interaction (FSI) method. The study investigates the possible link between the dynamic behaviour of an AAA and the blood viscosity variations attributed to the haematocrit value, while it also incorporates the pulsatile blood flow, the non-Newtonian behaviour of blood and the hyperelasticity of the arterial wall. It was found that blood viscosity has no significant effect on von Mises stress magnitude and distribution, whereas there is a close relation between the haematocrit value and the Wall Shear Stress (WSS) magnitude in AAAs. This WSS variation can possibly alter the mechanical properties of the arterial wall and increase its growth rate or even its rupture possibility. The relationship between haematocrit and dynamic behaviour of an AAA can be helpful in designing a patient specific treatment.
ARTICLE | doi:10.20944/preprints202203.0278.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: point-of-care ultrasound; internal medicine; lung ultrasound; echocardiography; abdominal ultrasound
Online: 21 March 2022 (08:39:57 CET)
Accumulated data show the utility of diagnostic multi-organ point-of-care ultrasound (PoCUS) in the assessment of patients admitted to an internal medicine ward. Assess whether multi-organ PoCUS (lung, cardiac, and abdomen) provides relevant diagnostic and/or therapeutic information in patients admitted for any reason to an internal medicine ward. Prospective, observational, and single-center study, at a secondary hospital. Multi-organ PoCUS was performed during the first 24 hours of admission. The sonographer had access to the patients’ medical history, physical examination, and basic complementary tests performed in the ED (laboratory, X-ray, electrocardiogram). We considered a relevant ultrasound finding if it implied a significant diagnostic and/or therapeutic change. In the second semester of 2019, 310 patients were enrolled (48.7% men, mean age 70.5 years). Relevant ultrasound findings were detected in 86 patients (27.7%) and in 60 (19.3%) triggered a therapeutic change. These findings were associated with older age (Mantel-Haenszel 2 = 25.6; p< .001) and higher degree of dependency (Mantel Haenszel 2 = 5.7; p = .017). Multi-organ PoCUS provides relevant diagnostic information, complementing traditional physical exam, and facilitates therapy adjustment, regardless of the cause of admission. Multi-organ PoCUS to be useful need to be systematically integrated into the decision-making process in internal medicine.
ARTICLE | doi:10.20944/preprints202012.0759.v1
Subject: Medicine & Pharmacology, Other Keywords: adolescents; cardiometabolic risk factors; insulin resistance; abdominal obesity; lifestyle; nutritional habits
Online: 30 December 2020 (15:16:17 CET)
The prevalence of cardiometabolic risk factors has increased in Slovakian adolescents as a result of serious lifestyle changes. This cross-sectional study aimed to assess the prevalence of insulin resistance (IR) and the associations with cardiometabolic and selected lifestyle risk factors in a sample of Slovak adolescents. In total, 2,629 adolescents (45.8% males) aged between 14 and 18 years were examined in the study. Anthropometric parameters, blood pressure, and resting heart rate were measured, fasting venous blood samples were analysed, and HOMA-IR was calculated. The mean HOMA-IR was 2.45±1.91 without a significant intersexual difference. IR (cut-off point for HOMA-IR=3.16) was detected in 18.6% of adolescents (19.8% males, 17.6% females). IR was strongly associated with overweight/obesity (especially central) and with almost all monitored cardiometabolic factors, except for TC and systolic BP in females. The multivariate model selected variables such as low level of physical fitness, insufficient physical activity, breakfast skipping, a small number of daily meals, frequent consumption of sweetened beverages, and low educational level of fathers as the significant risk factors of IR in adolescents. Recognizing the main lifestyle risk factors and early IR identification is important in terms of the performance of preventive strategies. Weight reduction, regular physical activity, and healthy eating habits can improve insulin sensitivity and decrease the incidence of metabolic syndrome, type 2 diabetes, and CVD in adulthood.
ARTICLE | doi:10.20944/preprints201907.0343.v1
Subject: Medicine & Pharmacology, Pediatrics Keywords: emergency department acute abdominal pain; isolated fallopian tube torsion; detorsion; salpingectomy
Online: 31 July 2019 (04:20:30 CEST)
Isolated fallopian tube torsions presenting to the emergency department are a very rare cause of childhood acute abdominal pain. Since the diagnosis to be made in the early period is of importance in terms of affecting tubal damage and fertility, it was aimed to evaluate the cases in the light of literature. Materials and Methods: This study included 10 patients under 18 years of age presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5±1.43 years (range: 12-17years). The demographic characteristics, surgical findings, and methods, concomitant pathology results of these patients were retrospectively evaluated. Results: The reason for admitting to the emergency department of 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 hours in 7 patients (70%) and was more than 24 hours in three patients (30%). Of the patients, 9 (90%) had tenderness in the lower abdominal quadrant, 5 (5%) had the defense, and 3 (30%) had a rebound. Nausea, vomiting, and leucocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Of the patients, 8 (80%) underwent open surgery and 2 (20%) underwent laparoscopic intervention. Detorsion was performed in 5 (50%) and salpingectomy was performed in 5 (50%) cases. Conclusion: Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the maintenance of fertility.
ARTICLE | doi:10.20944/preprints202104.0170.v1
Subject: Biology, Anatomy & Morphology Keywords: abdominal subcutaneous adipocytes; angiotensinogen; nuclear factor-kappa B; lipopolysaccharide; tumor necrosis factor-alpha
Online: 6 April 2021 (11:28:00 CEST)
Central adiposity is one of the significant determinants of obesity-related hypertension risk, which may arise due to the abdominal fat depot's pathogenic inflammatory nature. Pro-inflammatory cytokines and adipokines up-regulation through nuclear factor-kappa B (NF-κB) activation in adipose tissue has been considered an essential function in the pathogenesis of obesity-related hypertension. This study aimed to ascertain the NF-κB inhibitor (SN50) effect on TNF-α and angiotensinogen (AGT) secretion and expression in mediating the anti-inflammatory effect through its impact on NF-κB activity in humans adipose tissue. Primary human adipocytes were isolated from 20 subjects among 10 overweight and 10 obese with and without hypertension and treated with 10ng/ml LPS in the presence and absence of NF-κB inhibitor, SN50 (50μg/ml). TNF-α secretion and NF-κB p65 activity were detected in supernatants extracted from cultured cells treated and untreated with LPS (10ng/ml) and SN50 (50μg/ml) using enzyme-linked immunosorbent assay (ELISA). The western blot technique detected the protein of NF-κB p65 and AGT. Gene expression of TNF-α and AGT was detected in cells and performed using quantitative real-time polymerase chain reaction (RT-PCR). Treatment of AbdSc adipocytes with LPS (10ng/ml) caused a significant increase in NF-κB p65 among overweight and obese subjects with and without hypertension (P= 0.001) at 24 hours incubation. In contrast, SN50-NF-κB inhibitor causes a reduction of NF-κB p65 in overweight (P= <0.001) and obese subjects with and without hypertension (P= 0.001) at 24 hours incubation. Treatment of AbdSc adipocytes with 10ng/ml LPS caused a significant increase in TNF-α secretion in overweight and obese subjects at all-time points (P= <0.001), whereas SN50 leads to a decrease in TNF-α secretion at 3 and 12 hours incubation. Treatment of AbdSc adipocytes with LPS (10ng/ml) caused increased TNF-α and AGT gene expression twofold compared with untreated cells, whereas, in the presence of SN50, it reduces mRNA AGT levels in both groups. Taken together, these adipokines with NF-κB activation may represent essential biomarkers to evaluate hypertension risk and to provide insight into the pathogenesis of obesity-related hypertension.
ARTICLE | doi:10.20944/preprints202209.0242.v1
Subject: Medicine & Pharmacology, Gastroenterology Keywords: pancreatic cancer (PC); abdominal ultrasonography (US); surveillance; prognosis; medical checkup; 5-year survival; cancer screening
Online: 16 September 2022 (08:08:33 CEST)
Recent advancements in surgical and anti-cancer therapies have provided significant hope of long survival in patients with pancreatic cancer (PC). To realize this hope, routine medical checkups of asymptomatic people should be performed to identify operable PCs. In this study, we evaluated the efficacy of medical checkups using abdominal ultrasonography (US). We retrospectively analyzed 374 patients with PC at our institute between 2010 and 2021. We divided these patients into several groups according to the diagnostic approach and compared their background and prognosis. These groups comprised PCs diagnosed through (a) symptoms, 242 cases; (b) US during medical checkup for asymptomatic individuals, 17; and other means. Of the 375 patients, 192 were men (51.3%), and the median age was 74 years (34–105). Tumors were located in the pancreatic tail in 67 patients (17.9%). Excision ratio and 5-year survival rate were significantly better in group (b) than in (a) (58.8% vs. 23.1%, P<0.01 and 42.2% vs. 9.4%, P<0.001, respectively). The prognosis of patients diagnosed using US during medical checkup was better than that of patients identified through symptomatic presentation of PC. US for asymptomatic individuals with PC might be useful for promoting better prognosis of PCs.
ARTICLE | doi:10.20944/preprints202206.0230.v1
Subject: Medicine & Pharmacology, Other Keywords: COVID-19; carotid stenosis; abdominal aortic aneurysm; chronic limb-threatening ischemia; amputation; deep venous thrombosis
Online: 16 June 2022 (04:40:54 CEST)
Background: To investigate the effects of the COVID-19 lockdowns on the vasculopathic population. Methods: The Divisions of Vascular Surgery of the southern Italian peninsula joined this multicenter retrospective study conducted through cross-sectional survey. Each received a 13-point questionnaire, investigating the hospitalization rate of vascular patients in the first 11 months of the COVID-19 pandemic and in the preceding 11 months. Results: 27 out of 29 Centers were enrolled. April-December 2020 (7092 patients) vs 2019 (9161 patients): post-EVAR surveillance, treatment for Rutherford category 3 peripheral arterial disease, and asymptomatic carotid stenosis revascularization significantly decreased [1484 (16.2%) vs 1014 (14.3%), p=0.0009; 1401 (15.29%) vs 959 (13.52%), p=0.0006; and 1558 (17.01%) vs 934 (13.17%), p<0.0001, respectively]; while revascularization or major amputations for chronic limb-threatening ischemia, and urgent revascularization for symptomatic carotid stenosis significantly increased [1204 (16.98%) vs 1245 (13.59%), p<0.0001; 355 (5.01%) vs 358 (3.91%), p=0.0007; and 153 (2.16%) vs 140 (1.53%), p=0.0009, respectively]. Conclusions: The suspension of elective activities during the COVID-19 pandemic caused a significant reduction in asymptomatic carotid stenosis revascularization, treatment for Rutherford 3 peripheral arterial disease, post-EVAR surveillance. Contestually, we observed a significant increase in urgent revascularization for symptomatic carotid stenosis, and revascularization or major amputations for chronic limb-threatening ischemia.
ARTICLE | doi:10.20944/preprints202209.0475.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: catheter-associated infection; CAUTI; urinary tract infection; healthcare-associated infection; active drain line clearance; burns; intra-abdominal pressure; measurement
Online: 30 September 2022 (04:13:24 CEST)
OBJECTIVE A quality improvement study to assess catheter-associated urinary tract infection (CAUTI) rate post-implementation of a bladder catheter with integrated active drain line urine clearance and automated intra-abdominal pressure monitoring in a burn intensive care unit (ICU). DESIGN Eight-year retrospective before and after study (2015–2022). SETTING A single American Burn Association verified Burn Center with fourteen inpatient beds. PATIENTS Patients meeting criteria for admission to a Burn Center METHODS Retrospective cohort study following the implementation of a novel urine output monitoring system with integrated drain line and urine clearance. Data from a 48-month (from January 2015-December 2018) historical control (period 1) were compared to data from a 28-month (from January 2020 to April 2022) post-implementation period (period 2). Pre- and post-implementation CAUTI event incidences were compared. Charts were reviewed to characterize the patients. RESULTS A total of 42 CAUTIs in 2243 patients were identified using the National Health and Safety Network (NHSN) definition during the analyzed period. There were 40 CAUTI events in period 1 and two CAUTIs in period 2. The incidence of CAUTI events pre-implementation was 0.030 (mean of 10 CAUTI events per year) compared to 0.002 (mean of 1 CAUTI event per year) post-implementation of an automatic drain line clearing UO monitoring system showing a significant reduction in CAUTI events (P<0.01, risk ratio novel vs. gravity bladder catheter 0.071, 95% confidence interval: 0.017-0.294). CONCLUSIONS CAUTIs were reduced in the period following the implementation of a novel urinary catheter system with an integrated active drain line and urine clearance in burn patients.
REVIEW | doi:10.20944/preprints202204.0166.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: acute kidney injury; intra-abdominal pressure; oxidative stress; renal cortical blood flow; renal medullar blood flow; renal lymphatic drainage; venous congestion
Online: 18 April 2022 (10:45:36 CEST)
Acute kidney injury (AKI), especially if recurring represents a risk factor for future chronic kidney disease. In intensive care units, increased intraabdominal pressure is well-recognized as a significant contributor of AKI. However, the importance of transiently increased intra-abdominal pressures procedures is less commonly appreciated during laparoscopic surgery, the use of which has rapidly increased over the last few decades. Unlike the well-known autoregulation of the renal cortical circulation, medulla perfusion is modulated via partially independent regulatory mechanisms and strongly impacted by changes in venous and lymphatic pressures. In our review paper, we will provide a comprehensive overview of this evolving topic, covering a broad range from basic pathophysiology up to and including current clinical relevance. Key regulators of oxidative stress such as ischemia-reperfusion injury, the activation of inflammatory response and humoral changes interacting with procedural pneumoperitoneum formation and AKI risk will be recounted. Moreover, we present an in-depth review of the interaction of pneumoperitoneum formation with general anesthetic agents and animal models of congestive heart failure. A better understanding of the relationship between pneumoperitoneum formation and renal perfusion will support basic and clinical research, leading to improved clinical care and collaboration among specialists.
ARTICLE | doi:10.20944/preprints202103.0745.v1
Subject: Life Sciences, Biochemistry Keywords: abdominal aortic aneurysm; pulse wave analysis; one-dimensional modelling; in silico pulse waves; machine learning; recurrent neural network; long short-term memory
Online: 30 March 2021 (14:05:44 CEST)
An abdominal aortic aneurysm (AAA) is usually asymptomatic until rupture, which is associated with extremely high mortality. Consequently, early detection of AAAs is of paramount importance in reducing mortality; however, most AAAs are detected by medical imaging incidentally. The aim of this study was to investigate the feasibility of machine learning-based pulse wave (PW) analysis for the early detection of AAAs using a database of in silico PWs. PWs in the large systemic arteries were simulated using one-dimensional blood flow modelling. A database of in silico PWs representative of subjects (aged 55, 65 and 75 years) with different AAA sizes was created by varying the AAA-related parameters with major impacts on PWs – identified by parameter sensitivity analysis – in an existing database of in silico PWs representative of subjects without AAA. Then, a machine learning architecture for early detection of AAAs was proposed, which was trained and tested using the new in silico PW database. The parameter sensitivity analysis revealed that the AAA maximum diameter and stiffness of the large systemic arteries were the dominant AAA-related biophysical properties that significantly influence the PW. The simulated PW indexes extracted from the database showed that the PW was not only influenced by the presence of an AAA but was also significantly affected by multiple cardiovascular parameters that compromised the detection of AAAs by using individual PW indexes. Alternatively, the trained machine learning model performed well in classifying normal and AAA conditions using digital photoplethysmogram PWs from the database. These findings suggest that machine learning-based PW analysis is a promising approach for AAA screening using PW signals acquired by wearable devices.